Editorial: Can We Prevent Inflammatory Bowel Disease? Authors' Reply

Abstract

We sincerely appreciate the insightful comments from Ho and Mak regarding our recent study [1], which highlights the potential of lifestyle modification as a primary preventive strategy for inflammatory bowel disease (IBD) [2]. Utilising data from 105,715 participants aged 40–70 years in the UK Biobank Study, our analysis demonstrated a significant association between adherence to a combination of healthy lifestyle behaviours—never smoking, optimal sleep duration, high levels of vigorous physical activity, high dietary quality and moderate alcohol intake—and a reduced risk of incident IBD, including both Crohn's disease and ulcerative colitis [2]. Even after adjusting for potential confounders, participants adhering to one, two or three to five healthy lifestyle behaviours exhibited adjusted hazard ratios (95% confidence intervals) of 0.75 (0.59–0.97), 0.72 (0.56–0.92) and 0.50 (0.37–0.68), respectively (p for trend < 0.001), compared with those who engaged in none of these behaviours [2].

Given the increasing incidence of IBD worldwide, particularly in newly industrialised nations [3], Ho and Mak aptly underscore the urgent need for effective preventive strategies to mitigate disease burden and reduce healthcare system pressures [1]. Despite the growing recognition of lifestyle factors in disease prevention, current consensus guidelines predominantly emphasise diagnosis and treatment for IBD rather than comprehensive prevention strategies [6, 4]. IBD is a multifactorial disease influenced by genetic predisposition, environmental exposures and gut microbiota composition [7]. Our findings highlight the collective benefits of multiple healthy lifestyle behaviours in lowering IBD risk and suggest that lifestyle modification may attenuate the impact of etiological factors on disease development.

To effectively implement IBD prevention, primary healthcare providers must play a pivotal role in facilitating health behaviour change during routine consultations, as they often serve as the first point of contact within the healthcare system [8, 9]. The World Health Organisation advocates for the use of the ‘5As’ framework (Ask, Advise, Assess, Assist and Arrange), which can be seamlessly integrated into healthcare delivery at all levels, to guide primary care practitioners in delivering brief, structured counselling on health risk factors [10]. Beyond individual clinical efforts, fostering a supportive macro-environment is essential to encourage the adoption and maintenance of healthy behaviours. This necessitates coordinated action from national and local authorities. In the UK, national guidelines on behaviour change urge policymakers and healthcare commissioners to contribute actively to the design and implementation of evidence-based, sustainable interventions [5]. These efforts should be supported by institutional policies, resource allocation, workforce training and systematic evaluation to ensure long-term effectiveness [5].

In conclusion, our study provides empirical evidence demonstrating that the combined adherence to five key healthy lifestyle behaviours significantly reduces the risk of IBD in middle-aged and older adults. Although these findings offer promising insights into disease prevention, further research is warranted to validate these associations across diverse populations and elucidate underlying biological mechanisms. The successful promotion of these lifestyle behaviours for IBD prevention requires a concerted effort from primary healthcare providers, alongside robust support from local and national authorities, to foster sustainable health behaviour change among the general population.