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Defining gene–lifestyle interactions in inflammatory bowel disease: progress towards understanding disease pathogenesis
  1. Jianhui Zhao1,
  2. Jie Chen1,2,
  3. Yuhao Sun1,
  4. Shuai Yuan3,
  5. Judith Wellens4,
  6. Rahul Kalla5,
  7. Evropi Theodoratou6,7,
  8. Xue Li1,
  9. Jack Satsangi8
  1. 1 School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
  2. 2 Department of Gastroenterology, Central South University Third Xiangya Hospital, Changsha, Hunan, China
  3. 3 Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4 Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus Hospital Pharmacy, Leuven, Belgium
  5. 5 Medical Research Council Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
  6. 6 Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
  7. 7 Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
  8. 8 Translational Gastro-Intestinal Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Xue Li, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China;{at}

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Recently, Lopes et al quantified the effect of modifiable lifestyle factors in inflammatory bowel disease (IBD) prevention using population attributable risk, and reported that 42.9% of Crohn’s disease (CD) cases and 44.4% of ulcerative colitis (UC) cases could have been prevented by lifestyle interventions. This interesting result was based on 6 prospective cohorts including 3 US cohorts with 208 070 participants and 3 large European cohorts that were used for validation.1 Undoubtedly, this well-performed study illustrates the possible merits of lifestyle modification as a prevention strategy for IBD.

However, we would like to argue that lifestyle modification as such cannot be uncoupled from the genetic background. Although the importance of genetic susceptibility in the development of IBD is widely accepted,2 this was unfortunately not assessed in Lopes et al ‘s study. We recently conducted a prospective cohort study on the UK Biobank in >450 000 individuals, …

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  • JZ and JC are joint first authors.

  • Twitter @rahul_kalla

  • Contributors XL and JS conceptualised the project. JZ wrote the first draft. All authors critically reviewed the manuscript for important intellectual content. XL is the study guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.