Editorial: Can We Prevent Inflammatory Bowel Disease?

Abstract

Inflammatory Bowel Disease (IBD), characterised by chronic inflammation of the gastrointestinal tract, can lead to a range of disabling symptoms and complications that impact both young and elderly individuals. It was observed that not only is the prevalence of IBD increasing in urbanised regions across the globe, but the incidence of IBD in newly industrialised regions has been rising as well [1]. The increasing burden of this chronic disease poses significant challenges to our healthcare systems. The exact causes of IBD remain unclear, but recent studies have identified several modifiable environmental risk factors that contribute to its development [2]. One approach to mitigating these risks is through the adoption of a healthy lifestyle.

In the present study, Ho et al. studied the association of healthy lifestyle behaviours and risks of IBD development using the data from more than 100,000 individuals aged 40–70 from the UK Biobank [3]. The authors identified five lifestyle behaviours, including never smoking, optimal sleep, high levels of vigorous physical activity, high dietary quality, and moderate alcohol intake, as critical factors in mitigating IBD development. The most fascinating finding was that adopting a combination of healthy lifestyle behaviours, but not a single individual healthy behaviour, was associated with a greater reduction in the risk of developing both CD and UC. Although IBD mainly affects the young population, there is a bimodal pattern of disease onset, with another peak occurring between 60 and 70 years of age. With the increasing prevalence of elderly-onset IBD, which has been shown to exhibit disease activity at least as complex as that of adult-onset IBD [4], this study could still provide important insights on important preventive strategies against IBD.

While previous studies mainly focus on the effect of individual environmental factors in IBD development [5], this study provides a new insight: no single lifestyle factor holds a magic bullet. Instead, the combined impact of healthy lifestyle choices creates a powerful protective effect. IBD is a complex, multi-factorial disease where dysbiosis of the gut microbiome, environmental factors, and host genetics are implicated in disease development. Diet and host immune responses determine gut microbial composition and function. Excessive intake of specific macronutrients enriched in a Western diet promotes experimental gut inflammation by perturbation of host–microbe commensalism [6]. Physical activity, on the contrary, influences the composition and diversity of the microbiome, reducing inflammation and intestinal permeability [7]. Sleep, often overlooked, also plays a critical role, as disruptions to the sleep–wake cycle can significantly alter the gut microbiome's function and resilience [8]. The gut microbiome, in turn, produces metabolites and hormones that regulate appetite, satiety, energy metabolism, and overall physiological balance, which is further influenced by the body's physical activity and sleep patterns. This complex interplay highlights the importance of a holistic approach to health, where diet, exercise, and sleep, together with no smoking and controlled alcohol intake, are considered in conjunction with the gut microbiome to promote optimal health and resilience. Effective preventive measures are crucial in slowing down the prevalence of any chronic illness, thus alleviating pressure on the health system. As physicians, we should encourage individuals to cultivate a lifestyle that promotes resilience, well-being, and long-term health. Public health initiatives and policymakers should consider prioritising resources to promote healthy lifestyle awareness and modification.