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Review
. 2025 Apr 4;19(4):jjaf042.
doi: 10.1093/ecco-jcc/jjaf042.

Environmental risk factors of inflammatory bowel disease: toward a strategy of preventative health

Tarun Chhibba  1 , Beatriz Gros  2   3 , James A King  4 , Joseph W Windsor  4 , Julia Gorospe  4 , Haim Leibovitzh  1   5 , Mingyue Xue  1   5 , Williams Turpin  1   5 , Kenneth Croitoru  1   5 , Ashwin N Ananthakrishnan  6 , Richard B Gearry  7 , Gilaad G Kaplan  4
Affiliations
Review

Environmental risk factors of inflammatory bowel disease: toward a strategy of preventative health

Tarun Chhibba et al. J Crohns Colitis. .

Abstract

The pathogenesis of inflammatory bowel disease (IBD) involves a complex interplay between genetic, environmental, and microbial factors. Many of these environmental determinants are modifiable, offering opportunities to prevent disease or delay its onset. Advances in the study of preclinical IBD cohorts offer the potential to identify biomarkers that predict individuals at high risk of developing IBD, enabling targeted environmental interventions aimed at reducing IBD incidence. This review summarizes findings from 79 meta-analyses on modifiable environmental factors associated with the development of IBD. Identified risk factors include smoking, Western diets, ultra-processed foods, and early life antibiotic use, while protective factors include breastfeeding, Mediterranean diets rich in fiber, plant-based foods, and fish, along with an active physical lifestyle. Despite the promise shown by observational data, interventional or randomized controlled studies evaluating the efficacy of modifying environmental risk factors remain limited and mostly focus on dietary intervention. This review aims to inform the design of higher quality interventional and randomized controlled studies for disease prevention while providing actionable guidance to healthcare providers on reducing the risk of developing IBD through environmental modifications.

Keywords: Crohn’s disease; environmental health; incidence; predisease cohorts; ulcerative colitis.

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Conflict of interest statement

G.G.K. has received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer, Amgen, and Takeda. He has received research support from Ferring, Janssen, AbbVie, GlaxoSmithKline, Merck, and Shire. He has been a consultant for Gilead. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. September 7, 2018. B.G. has received honoraria for speaking or consultancy from Galapagos, AbbVie, Janssen, Takeda, Pfizer, Roche, and Galapagos. R.B.G. has received honoraria for speaking or consultancy from AbbVie, Janssen, Zespri, Ferring, and Takeda. He has received research support from Zespri, Janssen, AbbVie, and Goodman-Fielder. A.N.A. has served as a consultant to Geneoscopy. K.C. has received honoraria for speaking and consultancy from AbbVie, Janssen, Pfizer, Takeda, Shire, and Ferring. He has received research support from Janssen and AbbVie.

Figures

Figure 1.
Figure 1.
Environmental determinates of Crohn’s disease and ulcerative colitis across the age continuum. “*” are environmental factors associated exclusively with Crohn’s disease, while “**” indicates factors associated exclusively with ulcerative colitis.
Figure 2.
Figure 2.
Dietary stratification of pro-inflammatory and anti-inflammatory foods.
Figure 3.
Figure 3.
A framework for reducing the incidence of IBD that integrates current knowledge to support future interventional environmental health research, while providing guidance today to promote disease prevention in the future. IBD, inflammatory bowel disease.
See this image and copyright information in PMC

References

    1. Kaplan GG, Ng SC.. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology. 2017;152:313–321.e2. https://doi.org/10.1053/j.gastro.2016.10.020 - DOI - PubMed
    1. Molodecky NA, Soon IS, Rabi DM, et al.Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.e42; quiz e30. https://doi.org/10.1053/j.gastro.2011.10.001 - DOI - PubMed
    1. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12:720–727. https://doi.org/10.1038/nrgastro.2015.150 - DOI - PubMed
    1. Ng SC, Shi HY, Hamidi N, et al.Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017;390:2769–2778. https://doi.org/10.1016/S0140-6736(17)32448-0 - DOI - PubMed
    1. Coward S, Clement F, Benchimol EI, et al.Past and future burden of inflammatory bowel diseases based on modeling of population-based data. Gastroenterology. 2019;156:1345–1353.e4. https://doi.org/10.1053/j.gastro.2019.01.002 - DOI - PubMed