Does your lifestyle increase your risk of IBS?

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The researchers of a recent study published in the Gut journal determined the relationship between healthy lifestyle behaviors and the incidence of irritable bowel syndrome (IBS).

Study: Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large populationbased prospective cohort study. Image Credit: Meeko Media/Shutterstock.comStudy: Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large populationbased prospective cohort study. Image Credit: Meeko Media/


IBS is a functional gastrointestinal disease characterized by recurring stomach discomfort and irregular bowel movements. Disease management has significant economic burdens. There is no accepted primary preventive method; however, five modifiable lifestyle variables can modify IBS risk.

Current recommendations do not promote lifestyle modification programs as the main preventative strategies. Current therapies attempt to alleviate symptoms but are inconclusive or have side effects.

IBS patients frequently report concomitant psychological illnesses, increased suicidal ideation, and a worse life quality. Primary care physicians should aggressively offer interventions to modify health habits during routine consultations.

About the study

In the present population-based prospective cohort study, researchers investigated whether healthy lifestyle habits such as optimal sleep, no smoking, moderate alcohol consumption, high physical activity levels, and high diet quality are associated with irritable bowel syndrome.

The team enrolled 64,268 United Kingdom Biobank (UKBB) participants aged between 37 and 73 years without prior IBS diagnosis from 2006 to 2010, with follow-ups through 2022.

The primary study exposures included five healthy habits, i.e., optimal sleep, never smoking, high diet quality, moderate alcohol consumption, and high physical activity levels. They assessed all the lifestyle behaviors using structured questionnaires on a self-report basis.

The primary outcome measure was IBS incidence, defined using the International Classification of Diseases, 10th revision (ICD-10) codes.

The study participants completed touchscreen questionnaires and verbal interviews on demographics, lifestyle, and health. They were also subject to physical examinations and provided samples.

The team included individuals who completed two or more 24-hour diet recall questionnaires (126,841 individuals, including alcohol consumption assessments) from the entire cohort.

They excluded individuals documenting unrealistic calorie intake (below 800 kcal or above 5,000 kcal per day for males and below 500 kcal or above 4,000 kcal per day for females), those with missing information on healthy lifestyle habits, and those with IBS diagnoses at baseline from the study.

The team followed the participants through February 1, 2022. They performed Cox proportional hazard modeling to determine the hazard ratios (HRs) for the relationship between healthy habits and IBS incidence.

Study covariates included age, body mass index (BMI), sex, geographic locations, employment status, marital status, anxiety, depression, headaches, joint and back pain, asthma, osteoporosis, endometriosis, gastrointestinal infections, family IBS history, and ectopic pregnancy.

The team conducted sensitivity analyses to examine the impact of five lifestyle behaviors on individuals with IBS.

They excluded those diagnosed based on self-documentation, defined healthy alcohol consumption behaviors differently, and used less stringent physical activity definitions.

They considered healthy participants as those engaging in moderate to extensive physical exercises and performed separate analyses for each lifestyle behavior, with model adjustments for other behaviors.


Over a 13-year follow-up (mean), the team recorded 961 (two percent) new-onset IBS cases. Compared to individuals who did not practice any healthy lifestyle habit, those who practiced three, four, or five healthy habits had an increased likelihood of being younger, female, married, having a lower body mass index, with in-paid jobs, or self-employment status, and a decreased likelihood of having IBS history in their families.

They also were less likely to be anxious, depressed, or suffer from headaches, joint pain, back pain, gastrointestinal disease, and asthma.

Among 64,268 individuals (mean age of 56 years), 55% (n=35,342) were female, 12% (n=7,604) practiced no healthy habits, 32% (n=20,662) practiced one healthy habit, 34% (n=21,901) practiced two habits, and 22% (n=14,101) practiced three to five habits at study initiation.

The multivariate-adjusted HRs related to having one, two, three, or five behaviors for incident IBS were 0.8, 0.6, and 0.6, respectively.

No smoking (0.9), optimal sleep (0.7), and high physical activity levels (0.8) showed significant and independent inverse correlations with IBS risk.

The team observed no statistically significant interactions between the associations and gender, age, job status, geographic locations, gastrointestinal infections, endometriosis, IBS history among family members, or lifestyle behaviors.

Compared to unhealthy lifestyles, the adjusted hazard ratios associated with practicing one, two, and three to five healthy habits were 0.8, 0.6, and 0.6, respectively. Sensitivity analyses yielded similar findings.


Overall, the study findings showed that adopting good lifestyle choices such as never smoking, getting enough sleep, engaging in regular physical exercise, eating a well-balanced diet, and drinking in moderate amounts can minimize the prevalence of IBS.

The study findings indicated that lifestyle changes might be an effective primary strategy for IBS prevention.

However, the study discovered potential correlations that warrant additional exploration. First, the percentage of women improved across various healthy living activities, perhaps for health reasons such as relieving menopausal symptoms and lowering breast cancer risk.

Second, baseline sadness reduced as the frequency of healthy activities increased, showing an inverse link between depressive symptoms and lifestyle choices.

Journal reference:
  • Ho FF, Sun H, Zheng H, et al. (2024) Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large population based prospective cohort study, Gut, doi:10.1136/gutjnl-2023-331254.

Pooja Toshniwal Paharia

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.


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