During a median follow-up of 14.6 years, 583 deaths were identified among 5052 patients with inflammatory bowel disease (IBD).
Patients with a favourable lifestyle had a significantly lower risk of all-cause mortality in IBD, with a hazard ratio of 0.56.
Favourable lifestyle also correlated with reduced mortality risk in ulcerative colitis (hazard ratio of 0.61) and Crohn's disease (hazard ratio of 0.49).
Approximately 18.9% of the reduced risk of mortality was potentially mediated by metabolic signatures linked to lifestyle.
Higher values were associated with lower all-cause mortality, with a hazard ratio of 0.65 for values above the median.
Similar associations were observed in subgroup and sensitivity analyses.
Simplified
BACKGROUND: Limited evidence has investigated the effect of a on mortality in patients with inflammatory bowel disease (IBD). We aimed to assess the relationship between a healthy lifestyle and all-cause mortality in IBD, as well as the underlying metabolic mechanisms in a prospective cohort.
METHODS: Overall, 5052 IBD patients free of cancer (aged 57.0±8.0 years, 48.5% men) were included from UK Biobank cohort. A healthy lifestyle was defined as a normal body mass index, never smoking, moderate alcohol consumption, regular physical activity, adequate sleep duration and healthy diet. The primary outcome was all-cause mortality. Lifestyle-related metabolic signatures were constructed by linear regression and elastic net regression in patients with metabolomics data. A multivariable Cox proportional hazards model was used to assess associations between lifestyle, and all-cause mortality. The mediation effect of lifestyle-related metabolic signatures was estimated through the Cox marginal structural model.
RESULTS: During a median of 14.6 years' follow-up, 583 deaths were identified. Compared with unfavourable lifestyle, those with favourable lifestyle showed significantly lower risk of all-cause mortality in IBD (HR=0.56, 95% CI 0.46 to 0.68), ulcerative colitis (UC) (HR=0.61, 95% CI 0.48 to 0.79) and Crohn's disease (HR=0.49, 95% CI 0.36 to 0.67), and 18.9% of the reduced risk was mediated by metabolic signature. Metabolic signature was significantly associated with lower all-cause mortality, with HR of 0.65 (95%CI 0.49 to 0.85) for values above versus below the median and 0.73 (95%CI 0.64 to 0.83) for per SD increase. Subgroup and sensitivity analyses demonstrated similar results.
CONCLUSION: A healthy lifestyle is associated with lower mortality in IBD patients. This beneficial effect may be mediated by metabolic signatures and related to favourable metabolic alterations.
Key numbers
0.56
Lower mortality risk
Hazard Ratio comparing favourable vs. unfavourable lifestyle
18.9%
Mediated risk reduction
Percentage of mortality risk reduction mediated by metabolic changes
583
Total deaths observed
Total deaths among 5052 IBD patients over 14.6 years
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