The environment has a modifying impact on every compartment relevant to infl ammatory bowel disease (IBD) pathogenesis.  Exposures from birth shape disease risk; breastfeeding lowers the risk of both Crohn’s disease (CD) and ulcerative colitis (UC).

Antibiotic use increases IBD risk, especially for CD, with a stronger effect in infancy and pediatric-onset IBD.  Current and former smoking heighten CD risk, while current smoking is linked to reduced UC risk; smoking cessation raises the risk of incident and relapsing UC.

Childhood and adult diets infl uence disease risk, encompassing both macro- and micronutrients.

Processing methods, emulsifiers and food additives may predispose to gut infl ammation. The Mediterranean diet reduces CD risk, while infl ammatory and high ultra-processed food consumption increases CD risk.

Stress and depressive symptoms correlate with incident IBD and potentially an increased risk of relapse. Psychotherapy interventions initially benefi t quality of life but lack sustained effects after therapy cessation, with no impact on disease activity.

Greater aerobic physical activity is associated with a reduced risk of UC and a lower risk of relapse. Reports suggest some benefi ts of low- to moderate-intensity exercise, though evidence is weak and benefi ts are inconsistent.


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