Engaging in More Healthy Lifestyle Behaviors May Reduce Risk of IBS

Vincent Chi-ho Chung, PhD, MSc

Credit: JC School of Public Health and Primary Care

Findings from a recent study are providing novel evidence of the association between adhering to healthy lifestyle behaviors and a reduced risk of subsequent irritable bowel syndrome (IBS) incidence.¹

The population-based prospective cohort study leveraged data from the UK Biobank to explore the impact of never smoking, optimal sleep, high level of vigorous physical activity, a high-quality diet, and moderate alcohol intake on the incidence of IBS, with results showing adhering to more of these healthy lifestyle behaviors was associated with less risk of IBS.¹

An estimated 10-15% of adults in the US have IBS, although only about 5-7% see a provider and receive a diagnosis. Lifestyle modifications are commonly recommended to help treat IBS and alleviate symptoms, although recent research has suggested healthier habits may also help prevent the onset of IBS and reduce its disease burden.²

“Consensus reports have provided recommendations on the diagnosis and treatment of IBS, but none of them have recommended any preventive measures,” wrote Vincent Chi-ho Chung, PhD, MSc, associate professor at the Jockey Club School of Public Health at the Chinese University of Hong Kong, and colleagues.¹ “Although lifestyle modification is recommended as a means of managing IBS symptoms, its potential role in preventing the onset of the condition has not been given due attention.”

To assess the association between healthy lifestyle behaviors and the incidence of IBS, investigators leveraged data from the UK Biobank, a large-scale prospective cohort study that recruited 502,492 participants 37-73 years of age between 2006 and 2010, collecting data on their demographics, health, and lifestyles. The present study examined 5 healthy lifestyle behaviors: never smoking, optimal sleep, high level of vigorous physical activity, high dietary quality, and moderate alcohol intake. The outcome of interest was the incidence of IBS, defined as code K58 under the International Classification of Diseases 10th revision (ICD-10).¹

Investigators excluded UK Biobank patients who completed less than 2 24-hour dietary recall questionnaires, reported unrealistic energy intake, were missing data on any of the lifestyle behaviors or key covariates, or had prevalent IBS at baseline. In total, 64,268 eligible patients were enrolled in the study and followed until 2022.¹

Investigators categorized participants into groups based on their adherence to the healthy lifestyle behaviors being examined. Of note, due to the relatively small number of individuals who had 3 (n = 11,079), 4 (n = 2767), and 5 (n = 255) healthy lifestyle behaviors, investigators pooled these patients together as a single group to increase the sample size for analysis.¹

Among the cohort, the mean age was 55.9 years and 55% of patients were female. In total, 7604 (11.8%) participants reported none of the 5 healthy lifestyle behaviors, 20,662 (32.1%) reported 1 behavior, 21,901 (34.1%) reported 2 behaviors, and 14,101 (21.9%) reported 3-5 behaviors at baseline. During a mean follow-up of 12.6 years, 961 (1.5%) incident IBS cases were recorded.^1,3

After adjusting for age, sex, employment status, geographic location, gastrointestinal infection, endometriosis, and family history of IBS, investigators noted adherence to a greater number of healthy lifestyle behaviors was significantly associated with a lower risk of incident IBS (all P <.05). Compared with not performing any of the 5 healthy lifestyle behaviors, the adjusted hazard ratio (aHR) associated with adhering to 1 behavior was 0.79 (95% CI, 0.65-0.96), 2 behaviors was 0.64 (95% CI, 0.53-0.78), and 3-5 behaviors was 0.58 (95% CI, 0.46-0.72) (P <.001).^1,3

Subgroup analyses by age, sex, employment status, geographic location, gastrointestinal infection, endometriosis, and family history of IBS yielded no significant interactions and thus no effect modifiers (all P ≥.05).¹

In separate analyses of each of the 5 lifestyle behaviors, never smoking (aHR, 0.86; 0.76-0.98; P = .02), high level of vigorous physical activity (aHR, 0.83; 95% CI, 0.73-0.95; P =.006) and optimal sleep (aHR, 0.73; 95% CI, 0.60-0.88; P =.001) demonstrated significant independent inverse associations with the incidence of IBS, although of a smaller magnitude than adhering to 3 to 5 behaviors. Investigators noted no significant independent associations were observed for healthy diet and moderate alcohol consumption.^1,3

Investigators pointed out there may be potential limitations to these findings, citing the large portion of participants excluded due to family history of IBS, potential inaccuracies of self-reported data on lifestyle behaviors, use of ICD-10 codes to identify incident IBS without considering Rome III criteria, and lack of consideration for changes in healthy lifestyle behaviors during the follow-up period.¹

Still, they expressed confidence in the study’s many strengths, concluding “Our findings underscore the value of lifestyle modification in the primary prevention of IBS and suggest that healthy lifestyle choices could significantly attenuate the effects of aetiological factors on the incidence of IBS.”

References:

1. ^{Ho FF, Sun H, Zheng H, et al. Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large population-based prospective cohort study. Gut. doi:10.1136/gutjnl-2023-331254}
2. ^{Cleveland Clinic. Irritable Bowel Syndrome (IBS). Diseases & Conditions. November 16, 2023. Accessed February 20, 2024. https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs}
3. ^{BMJ. Adopting healthy lifestyle strongly linked to lower irritable bowel syndrome risk. EurekAlert! February 20, 2024. Accessed February 20, 2024. https://www.eurekalert.org/news-releases/1034704?}