No Association Between Alcohol Consumption, Risk of Inflammatory Bowel Disease

A new analysis shows alocohol consumption does not increase the risk of either Crohn’s disease (CD) or ulcerative colitis (UC).

A team, led Kevin Casey, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, examined the association between alcohol consumption and inflammatory bowel disease (IBD).

While a true cause of IBD is not yet known, several risk factors have been identified, including diet, use of non-steroidal anti-inflammatory drugs, smoking, and stress. There is also the potential that alcohol consumption can be a risk factor.

“Among dietary factors, ethanol ingested from alcoholic beverages is known to impair gut barrier function and permeability, a critical biological pathway implicated in development of IBD,” the authors wrote. “Additionally, alcohol consumption has been linked to pro-inflammatory pathways. Specifically, short-term consumption can decrease T-cell activity, while longer-term use increases levels of TNF-ɑ, interleukin-1, and interleukin-6.”

Limited Data

However, there is limited data on how alcohol use impacts the risk of Crohn’s disease and ulcerative colitis. In the prospective cohort study, the investigators examined 237,835 participants from the Nurses’ Health Study, Nurses’ Health Study II, and Health Professional Follow-Up Study.

The team obtained data on alcohol consumption through questionnaires submitted every 4 years, with additional covariates obtained every 2 or 4 years. The questionnaires also included demographic information, physical information, disease status, medication information, and health behaviors.

They also obtained data on age, body mass index (BMI), sex, physical activity, smoking status, diet, and non-steroidal anti-inflammatory drug use at each visit, as well as family history of IBD in the 2012 or 2013 questionnaire.

A pair of physicians confirmed cases independently through a review of medical records. The investigators also used Cox proportional hazards regression to estimate age and multivariable-adjusted hazards ratios and 95% confidence intervals.

No Link Between Alcohol Use and IBD

Through 5.1 million person-years of follow-up, there were 370 cases of Crohn’s disease and 486 cases of ulcerative colitis identified.

And overall, increased alcohol consumption was not linked to cases of Crohn’s disease (Ptrend = 0.455) or ulcerative colitis (Ptrend = 0.745).

In addition, the multivariable-adjusted HRs for 15.0 + g/day of alcohol intake group were 0.84 (95% CI 0.56, 1.24) for Crohn’s disease and 1.08 (95% CI 0.77, 1.51) for ulcerative colitis, compared to non-users.

The investigators also analyzed alcohol subtypes and found only moderate consumption of beer—more than 1-4 servings per week—was marginally associatied with a reduced risk of Crohn’s disease. However, more than 4 servings per week of liquor was associated with an increased risk of ulcerative colitis.

“This prospective study did not identify a relationship between overall alcohol consumption and risk of CD or UC,” the authors wrote. “Our suggestive associations between alcohol types and risk of CD and UC deserve additional investigation.”

The study, “Alcohol consumption and risk of inflammatory bowel disease among three prospective US cohorts,” was published online in Alimentary Pharmacology & Therapeutics.