Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology

No association of alcohol use and the risk of ulcerative colitis or Crohn’s disease: data from a European Prospective cohort study (EPIC)

A Corrigendum to this article was published on 05 April 2017

Abstract

Background/Objectives:

The role of long-term alcohol consumption for the risk of developing ulcerative colitis (UC) and Crohn’s disease (CD) is unclear. For the first time, to prospectively assess the role of pre-disease alcohol consumption on the risk of developing UC or CD.

Subjects/Methods:

Nested within the European Prospective Investigation into Cancer and Nutrition (EPIC-IBD), incident UC and CD cases and matched controls where included. At recruitment, participants completed validated food frequency and lifestyle questionnaires. Alcohol consumption was classified as either: non-use, former, light (0.5 and 1 drink per week), below the recommended limits (BRL) (1 and 2 drinks per day), moderate (2.5 and 5 drinks per day), or heavy use (>2.5 and >5 drinks per day) for women and men, respectively; and was expressed as consumption at enrolment and during lifetime. Conditional logistic regression was applied adjusting for smoking and education, taking light users as the reference.

Results:

Out of 262 451 participants in six countries, 198 UC incident cases/792 controls and 84 CD cases/336 controls were included. At enrolment, 8%/27%/32%/23%/11% UC cases and 7%/29%/40%/19%/5% CD cases were: non-users, light, BRL, moderate and heavy users, respectively. The corresponding figures for lifetime non-use, former, light, BRL, moderate and heavy use were: 3%/5%/23%/44%/19%/6% and 5%/2%/25%/44%/23%/1% for UC and CD cases, respectively. There were no associations between any categories of alcohol consumption and risk of UC or CD in the unadjusted and adjusted odds ratios.

Conclusion:

There was no evidence of associations between alcohol use and the odds of developing either UC or CD.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Sartor RB . Microbial influences in inflammatory bowel diseases. Gastroenterology 2008; 134: 577–594.

    Article  CAS  Google Scholar 

  2. Abraham C, Cho JH . Inflammatory bowel disease. N Engl J Med 2009; 361: 2066–2078.

    Article  CAS  Google Scholar 

  3. Chapman-Kiddell CA, Davies PS, Gillen L, Radford-Smith GL . Role of diet in the development of inflammatory bowel disease. Inflamm Bowel Dis 2010; 16: 137–151.

    Article  Google Scholar 

  4. Cosnes J . Smoking, physical activity, nutrition and lifestyle: environmental factors and their impact on IBD. Dig Dis 2010; 28: 411–417.

    Article  Google Scholar 

  5. Hou JK, Abraham B, El-Serag H . Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 2011; 106: 563–573.

    Article  CAS  Google Scholar 

  6. Burger M, Mensink GB, Bergmann E, Pietrzik K . Characteristics associated with alcohol consumption in Germany. J Stud Alcohol 2003; 64: 262–269.

    Article  Google Scholar 

  7. Fillmore KM, Golding JM, Graves KL, Kniep S, Leino EV, Romelsjo A et al. Alcohol consumption and mortality. I. Characteristics of drinking groups. Addiction 1998; 93: 183–203.

    Article  CAS  Google Scholar 

  8. Wang HJ, Zakhari S, Jung MK . Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development. World J Gastroenterol 2010; 16: 1304–1313.

    Article  CAS  Google Scholar 

  9. Biasi F, Deiana M, Guina T, Gamba P, Leonarduzzi G, Poli G . Wine consumption and intestinal redox homeostasis. Redox Biology 2014; 2: 795–802.

    Article  CAS  Google Scholar 

  10. Bjarnason I . Alcohol: a friend or foe of IBD. Scand J Gastroenterol 2007; 42: 899–901.

    Article  Google Scholar 

  11. Cohen AB, Lee D, Long MD, Kappelman MD, Martin CF, Sandler RS et al. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci 2013; 58: 1322–1328.

    Article  CAS  Google Scholar 

  12. Swanson GR, Sedghi S, Farhadi A, Keshavarzian A . Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease. Alcohol 2010; 44: 223–228.

    Article  CAS  Google Scholar 

  13. Zutshi M, Hull TL, Hammel J . Crohn's disease: a patient's perspective. Int J Colorectal Dis 2007; 22: 1437–1444.

    Article  CAS  Google Scholar 

  14. Swanson GR, Tieu V, Shaikh M, Forsyth C, Keshavarzian A . Is moderate red wine consumption safe in inactive inflammatory bowel disease? Digestion 2011; 84: 238–244.

    Article  Google Scholar 

  15. Vagianos K, Clara I, Carr R, Graff LA, Walker JR, Targownik LE et al. What are adults with inflammatory bowel disease (IBD) eating? A closer look at the dietary habits of a population-based Canadian IBD Cohort. JPEN J Parenter Enteral Nutr 2014; 40: 405–411.

    Article  Google Scholar 

  16. Jussila A, Virta LJ, Pukkala E, Farkkila MA . Mortality and causes of death in patients with inflammatory bowel disease: A nationwide register study in Finland. J Crohns Colitis 2014; 8: 1088–1096.

    Article  Google Scholar 

  17. Manninen P, Karvonen AL, Huhtala H, Rasmussen M, Salo M, Mustaniemi L et al. Mortality in ulcerative colitis and Crohn's disease. A population-based study in Finland. J Crohns Colitis 2012; 6: 524–528.

    Article  Google Scholar 

  18. Jiang L, Xia B, Li J, Ye M, Deng C, Ding Y et al. Risk factors for ulcerative colitis in a Chinese population: an age-matched and sex-matched case-control study. J Clin Gastroenterol 2007; 41: 280–284.

    Article  Google Scholar 

  19. Samuelsson SM, Ekbom A, Zack M, Helmick CG, Adami HO . Risk factors for extensive ulcerative colitis and ulcerative proctitis: a population based case-control study. Gut 1991; 32: 1526–1530.

    Article  CAS  Google Scholar 

  20. Boyko EJ, Perera DR, Koepsell TD, Keane EM, Inui TS . Coffee and alcohol use and the risk of ulcerative colitis. Am J Gastroenterol 1989; 84: 530–534.

    CAS  PubMed  Google Scholar 

  21. Brandes JW, Stenner A, Martini GA . [Dietary habits of patients with ulcerative colitis (author's transl)]. Z Gastroenterol 1979; 17: 834–842.

    CAS  PubMed  Google Scholar 

  22. Katschinski B, Logan RF, Langman MJ . [Smoking and inflammatory bowel diseases]. Z Gastroenterol 1989; 27: 614–618.

    CAS  PubMed  Google Scholar 

  23. Nakarnura Y, Labarthe DR . A case-control study of ulcerative colitis with relation to smoking habits and alcohol consumption in Japan. Am J Epidemiol 1994; 140: 902–911.

    Article  Google Scholar 

  24. Han DY, Fraser AG, Dryland P, Ferguson LR . Environmental factors in the development of chronic inflammation: a case-control study on risk factors for Crohn's disease within New Zealand. Mutat Res 2010; 690: 116–122.

    Article  CAS  Google Scholar 

  25. Octoratou M, Merikas E, Malgarinos G, Stanciu C, Triantafillidis JK . A prospective study of pre-illness diet in newly diagnosed patients with Crohn's disease. Rev Med Chir Soc Med Nat Iasi 2012; 116: 40–49.

    PubMed  Google Scholar 

  26. Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 2002; 5: 1113–1124.

    Article  CAS  Google Scholar 

  27. Bergmann MM, Rehm J, Klipstein-Grobusch K, Boeing H, Schütze M, Drogan D et al. The association of pattern of lifetime alcohol use and cause of death in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Int J Epidemiol 2013; 42: 1772–1790.

    Article  Google Scholar 

  28. Klipstein-Grobusch K, Slimani N, Krogh V, Boeing H . Patterns EWGoD. Trends in self-reported past alcohol intake from 1950 to 1995 observed in eight European countries participating in the European Investigation into Cancer and Nutrition (EPIC) project. IARC Sci Publ 2002; 156: 169–172.

    CAS  PubMed  Google Scholar 

  29. American Heart Association: Alcohol, Wine and Cardiovascular Disease. Available at http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Alcohol-and-Heart-Health_UCM_305173_Article.jsp (accessed 16 December 2015).

  30. World Cancer Research Fund/American Institute for Cancer Research Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. AICR: Washington DC, USA, 2007. Available at http://www.dietandcancerreport.org/expert_report/recommendations/recommendation_alcoholic_drinks.php (accessed on 16 December 2015).

  31. National Institute of Alcoholism and Alcohol Abuse: Rethinking Drinking. Alcohol and your health. Available at http://rethinkingdrinking.niaaa.nih.gov/IsYourDrinkingPatternRisky/WhatsLowRiskDrinking.asp (accessed on 16 December 2015).

  32. Bergmann MM, Schutze M, Steffen A, Boeing H, Halkjaer J, Tjonneland A et al. The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort. Eur J Clin Nutr 2011; 65: 1079–1087.

    Article  CAS  Google Scholar 

  33. Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al. The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 2007; 61: 1037–1056.

    Article  CAS  Google Scholar 

  34. Fillmore KM, Kerr WC, Stockwell T, Chikritzhs T, Bostrom A . Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies. Addiction Research and Theory 2006; 14: 101–132.

    Article  Google Scholar 

  35. Rehm J, Irving H, Ye Y, Kerr WC, Bond J, Greenfield TK . Are Lifetime Abstainers the Best Control Group in Alcohol Epidemiology? On the Stability and Validity of Reported Lifetime Abstention. Am J Epidemiol 2008; 168: 866–871.

    Article  CAS  Google Scholar 

  36. Hart AR, Luben R, Olsen O, Tjonneland A, Linseisen J, Nagel G et al. Diet in the aetiology of ulcerative colitis: A European Prospective Cohort Study. Digestion 2008; 77: 57–64.

    Article  Google Scholar 

  37. Gentschew L, Ferguson LR . Role of nutrition and microbiota in susceptibility to inflammatory bowel diseases. Mol Nutr Food Res 2012; 56: 524–535.

    Article  CAS  Google Scholar 

  38. Karlinger K, Gyorke T, Mako E, Mester A, Tarjan Z . The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol 2000; 35: 154–167.

    Article  CAS  Google Scholar 

  39. Neuman MG, Nanau RM . Inflammatory bowel disease: role of diet, microbiota, life style. Transl Res 2012; 160: 29–44.

    Article  Google Scholar 

  40. World Health Organization (WHO) Global status report on alcohol and health, 2011. Availabe at http://www.who.int/substance_abuse/publications/drug_role_mandate/en/ (accessed on 16 December 2015).

  41. Zemore SE . The effect of social desirability on reported motivation, substance use severity, and treatment attendance. J Subst Abuse Treat 2012; 42: 400–412.

    Article  Google Scholar 

  42. Knott CS, Coombs N, Stamatakis E, Biddulph JP . All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015; 350: h384.

    Article  Google Scholar 

  43. Ng Fat L, Shelton N . Associations between self-reported illness and non-drinking in young adults. Addiction 2012; 107: 1612–1620.

    Article  Google Scholar 

  44. Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T . Do "Moderate" drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality. J Stud Alcohol Drugs 2016; 77: 185–198.

    Article  Google Scholar 

  45. Burisch J, Pedersen N, Cukovic-Cavka S, Brinar M, Kaimakliotis I, Duricova D et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014; 63: 588–597.

    Article  CAS  Google Scholar 

  46. Shivananda S, Lennard-Jones J, Logan R, Fear N, Price A, Carpenter L et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 1996; 39: 690–697.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the participants of the EPIC study for providing information, the data manager for processing the data and organising the databases and the technical staff for collecting the exposure and the outcome data in each of the 7 centres. This study was funded by The Sir Halley Stewart Trust, Crohn’s and Colitis UK and The NHS Executive Eastern Region. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by the Danish Cancer Society (Denmark); Ligue contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, Federal Ministry of Education and Research (Germany); Hellenic Health Foundation (Greece); The Italian Association for Research on Cancer, Compagnia San Paolo (Italy); Dutch Ministry of Health, Welfare and Sports, Dutch Prevention Funds, LK Research Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skane and Västerbotten (Sweden); Cancer Research UK, Medical Research Council (UK). VH received an intensification grant through the European Commission supported "BIOCAPS" project (FP-7-REGPOT 2012-2013-1, Grant agreement no. FP7-316265).

Author contributions

SSMC and ARH designed the study, recruited the centres, RL generated the master data set; WB calculated the alcohol variables, included them in the data set and analysed the data and MMB and VH wrote the paper. The remaining co-authors HB, KTK, FvS, BO, BBdM, KO, DP, GM, FC, MB, AO, AT, RK, VK, ER and ARH are principal investigators in their respective centres who contributed to the local design, development and enrolment of participants into their cohorts. These authors generated the local IBD databases, and contributed to the analysis and writing of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M M Bergmann.

Ethics declarations

Competing interests

MMB is the Guarantor of the article. The remaining authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bergmann, M., Hernandez, V., Bernigau, W. et al. No association of alcohol use and the risk of ulcerative colitis or Crohn’s disease: data from a European Prospective cohort study (EPIC). Eur J Clin Nutr 71, 512–518 (2017). https://doi.org/10.1038/ejcn.2016.271

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2016.271

This article is cited by

Search

Quick links