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Drinking water quality and inflammatory bowel disease: a prospective cohort study

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Abstract

Environmental factors, such as drinking water and diets, play an important role in the development of inflammatory bowel disease (IBD). This study aimed to investigate the associations of metal elements and disinfectants in drinking water with the risk of inflammatory bowel disease (IBD) and to assess whether diet influences these associations. We conducted a prospective cohort study including 22,824 participants free from IBD from the Yinzhou cohort study in the 2016–2022 period with an average follow-up of 5.24 years. The metal and disinfectant concentrations were measured in local pipeline terminal tap water samples. Cox regression models adjusted for multi-level covariates were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). During an average follow-up period of 5.24 years, 46 cases of IBD were identified. For every 1 standard deviation (SD) increase in the concentration of manganese, mercury, selenium, sulfur tetraoxide (SO4), chlorine, and nitrate nitrogen (NO3_N) were associated with a higher risk of IBD with the HRs of 1.45 (95% CI: 1.14 to 1.84), 1.51 (95% CI: 1.24–1.82), 1.29 (95% CI: 1.03–1.61), 1.52 (95% CI: 1.26–1.83), 1.26 (95% CI: 1.18–1.34), and 1.66 (95% CI: 1.32–2.09), whereas zinc and fluorine were inversely associated with IBD with the HRs of 0.42 (95% CI: 0.24 to 0.73) and 0.68 (95% CI: 0.54–0.84), respectively. Stronger associations were observed in females, higher income groups, low education groups, former drinkers, and participants who never drink tea. Diets have a moderating effect on the associations of metal and nonmetal elements with the risk of IBD. We found significant associations between exposure to metals and disinfectants and IBD. Diets regulated the associations to some extent.

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Acknowledgements

We would like to thank all co-authors. We would also like to extend our thanks to the Yinzhou cohort survey team for providing data and the training in using the dataset.

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Authors and Affiliations

  1. Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China

    Shuduo Zhou, Xuejie Dong, Zhisheng Liang, Ming Xu, Zhi-Jie Zheng & Zhenyu Zhang

  2. Institute for Global Health and Development, Peking University, Beijing, China

    Shuduo Zhou, Xuejie Dong, Ming Xu, Zhi-Jie Zheng & Zhenyu Zhang

  3. The Center for Disease Control and Prevention of Yinzhou District, Ningbo, Zhejiang, China

    Pengfei Chai

  4. Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, 310058, China

    Zongming Yang, Jianbing Wang & Kun Chen

  5. Department of Gastroenterology, Peking University First Hospital, Beijing, 100034, China

    Junxia Li & Guigen Teng

  6. School of Public Health, Capital Medical University, Beijing, 100069, China

    Shengzhi Sun

  7. Department of Epidemiology and Biostatistics, and National Clinical Research Center for Child Health of the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China

    Jianbing Wang

  8. Department of Epidemiology and Biostatistics, and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China

    Kun Chen

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  1. Shuduo Zhou
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  9. Ming Xu
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  10. Zhi-Jie Zheng
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Contributions

Shuduo Zhou, Zhenyu Zhang, and Kun Chen: drafting the manuscript, study design, data analysis, and interpretation. Shuduo Zhou, Pengfei Chai, Zhenyu Zhang, Shengzhi Sun, Ming Xu, and Jianbing Wang: study concept and design, and critical revision of the article for important intellectual content. Junxia Li, Guigen Teng, Xuejie Dong, Zhisheng Liang, and Zongming Yang: critical revision of the article for important intellectual content. All authors gave final approval of the version to be published.

Corresponding author

Correspondence to Zhenyu Zhang.

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Written informed consent from participants was obtained before they completed the questionnaires. All methods were carried out in accordance with relevant guidelines and regulations of Declaration of Helsinki.

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Highlights

• We found significant associations between exposure to metals and disinfectants and inflammatory bowel disease (IBD).

• Stronger associations were observed in females, higher income groups, and low education groups.

• Diets have a moderating effect on the associations of metal and nonmetal elements with the risk of IBD.

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Zhou, S., Chai, P., Dong, X. et al. Drinking water quality and inflammatory bowel disease: a prospective cohort study. Environ Sci Pollut Res 30, 71171–71183 (2023). https://doi.org/10.1007/s11356-023-27460-w

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