A Prospective Study of Cigarette Smoking and the Risk of Inflammatory Bowel Disease in Women

Overview

Journal Am J Gastroenterol

Specialty Gastroenterology

Date 2012 Jul 11

PMID 22777340

Citations 111

Authors

Leslie M Higuchi

Hamed Khalili

Andrew T Chan

James M Richter

Athos Bousvaros

Charles S Fuchs

Affiliations

Soon will be listed here.

Abstract

Objectives: Long-term data on the influence of cigarette smoking, especially cessation, on the risk of Crohn's disease (CD) and ulcerative colitis (UC) are limited.

Methods: We conducted a prospective study of 229,111 women in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II). Biennially, we collected updated data on cigarette smoking, other risk factors, and diagnoses of CD or UC confirmed by medical record review.

Results: Over 32 years in NHS and 18 years in NHS II, we documented 336 incident cases of CD and 400 incident cases of UC. Compared with never smokers, the multivariate hazard ratio (HR) of CD was 1.90 (95% confidence interval (CI), 1.42-2.53) among current smokers and 1.35 (95% CI, 1.05-1.73) among former smokers. Increasing pack-years was associated with increasing risk of CD (Ptrend < 0.0001), whereas smoking cessation was associated with an attenuation of risk. By contrast, the multivariate HR of UC was 0.86 (95% CI, 0.61-1.20) among current smokers and 1.56 (95% CI, 1.26-1.93) among former smokers. The risk of UC was significantly increased within 2-5 years of smoking cessation (HR, 3.06; 95% CI, 2.00-4.67) and remained persistently elevated over 20 years.

Conclusions: Current smoking is associated with an increased risk of CD, but not UC. By contrast, former smoking is associated with an increased risk of UC, with risk persisting over two decades after cessation.

Citing Articles

Novel Insights into the Pathogenesis of Inflammatory Bowel Diseases.

Calvez V, Puca P, Di Vincenzo F, Del Gaudio A, Bartocci B, Murgiano M Biomedicines. 2025; 13(2).

PMID: 40002718 PMC: 11853239. DOI: 10.3390/biomedicines13020305.

Influence of biological sex in inflammatory bowel diseases.

Tshikudi D, Bernstein C, Mishra S, Ghia J, Armstrong H Nat Rev Gastroenterol Hepatol. 2025; .

PMID: 39962330 DOI: 10.1038/s41575-025-01038-y.

Eosinophilic Esophagitis and Inflammatory Bowel Disease: What Are the Differences?.

Melhem H, Hendrik Niess J Int J Mol Sci. 2024; 25(15).

PMID: 39126102 PMC: 11313654. DOI: 10.3390/ijms25158534.

The Role of Environmental and Nutritional Factors in the Development of Inflammatory Bowel Diseases: A Case-Control Study.

Serrano-Fernandez V, Laredo-Aguilera J, Navarrete-Tejero C, Molina-Gallego B, Lopez-Fernandez-Roldan A, Carmona-Torres J Nutrients. 2024; 16(15).

PMID: 39125343 PMC: 11313778. DOI: 10.3390/nu16152463.

The Function of Necroptosis and Its Treatment Target in IBD.

Akanyibah F, Zhu Y, Jin T, Ocansey D, Mao F, Qiu W Mediators Inflamm. 2024; 2024:7275309.

PMID: 39118979 PMC: 11306684. DOI: 10.1155/2024/7275309.

References

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Moum B, Vatn M, Ekbom A, Fausa O, Aadland E, Lygren I . Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD Study Group of Gastroenterologists. Digestion. 1995; 56(5):377-81. DOI: 10.1159/000201262. View

Mahid S, Minor K, Soto R, Hornung C, Galandiuk S . Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc. 2006; 81(11):1462-71. DOI: 10.4065/81.11.1462. View

Baumgart D, Carding S . Inflammatory bowel disease: cause and immunobiology. Lancet. 2007; 369(9573):1627-40. DOI: 10.1016/S0140-6736(07)60750-8. View

Logan R, Edmond M, Somerville K, Langman M . Smoking and ulcerative colitis. Br Med J (Clin Res Ed). 1984; 288(6419):751-3. PMC: 1444645. DOI: 10.1136/bmj.288.6419.751. View

Boyko E, Koepsell T, Perera D, Inui T . Risk of ulcerative colitis among former and current cigarette smokers. N Engl J Med. 1987; 316(12):707-10. DOI: 10.1056/NEJM198703193161202. View

Chiuve S, Fung T, Rexrode K, Spiegelman D, Manson J, Stampfer M . Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA. 2011; 306(1):62-9. PMC: 3210472. DOI: 10.1001/jama.2011.907. View

Giovannucci E, Colditz G, Stampfer M, Hunter D, Rosner B, Willett W . A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. women. J Natl Cancer Inst. 1994; 86(3):192-9. DOI: 10.1093/jnci/86.3.192. View

Solomon C, Willett W, Carey V, Rich-Edwards J, Hunter D, Colditz G . A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA. 1997; 278(13):1078-83. View

10.

Abraham N, Selby W, Lazarus R, Solomon M . Is smoking an indirect risk factor for the development of ulcerative colitis? An age- and sex-matched case-control study. J Gastroenterol Hepatol. 2003; 18(2):139-46. DOI: 10.1046/j.1440-1746.2003.02953.x. View

11.

Garcia Rodriguez L, Gonzalez-Perez A, Johansson S, Wallander M . Risk factors for inflammatory bowel disease in the general population. Aliment Pharmacol Ther. 2005; 22(4):309-15. DOI: 10.1111/j.1365-2036.2005.02564.x. View

12.

Birrenbach T, Bocker U . Inflammatory bowel disease and smoking: a review of epidemiology, pathophysiology, and therapeutic implications. Inflamm Bowel Dis. 2005; 10(6):848-59. DOI: 10.1097/00054725-200411000-00019. View

13.

Cosnes J . Tobacco and IBD: relevance in the understanding of disease mechanisms and clinical practice. Best Pract Res Clin Gastroenterol. 2004; 18(3):481-96. DOI: 10.1016/j.bpg.2003.12.003. View

14.

Loftus Jr E, Silverstein M, Sandborn W, Tremaine W, Harmsen W, Zinsmeister A . Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gut. 2000; 46(3):336-43. PMC: 1727835. DOI: 10.1136/gut.46.3.336. View

15.

Fonager K, Sorensen H, Rasmussen S, Moller-Petersen J, Vyberg M . Assessment of the diagnoses of Crohn's disease and ulcerative colitis in a Danish hospital information system. Scand J Gastroenterol. 1996; 31(2):154-9. DOI: 10.3109/00365529609031980. View

16.

Thomas G, Rhodes J, Ingram J . Mechanisms of disease: nicotine--a review of its actions in the context of gastrointestinal disease. Nat Clin Pract Gastroenterol Hepatol. 2005; 2(11):536-44. DOI: 10.1038/ncpgasthep0316. View

17.

Hu F, Manson J, Stampfer M, Colditz G, Liu S, Solomon C . Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001; 345(11):790-7. DOI: 10.1056/NEJMoa010492. View

18.

Sarna L, Bialous S, Jun H, Wewers M, Cooley M, Feskanich D . Smoking trends in the Nurses' Health Study (1976-2003). Nurs Res. 2008; 57(6):374-82. PMC: 6706268. DOI: 10.1097/NNR.0b013e31818bf38b. View

19.

Tobin M, Logan R, Langman M, McConnell R, Gilmore I . Cigarette smoking and inflammatory bowel disease. Gastroenterology. 1987; 93(2):316-21. DOI: 10.1016/0016-5085(87)91021-3. View

20.

Li W, Han J, Qureshi A . Smoking and risk of incident psoriatic arthritis in US women. Ann Rheum Dis. 2011; 71(6):804-8. PMC: 4179887. DOI: 10.1136/annrheumdis-2011-200416. View