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This large prospective cohort study highlights that the risk of inflammatory bowel disease (IBD) related to alcohol consumption is significantly influenced by an individual’s acetaldehyde metabolism capacity. While red wine intake was associated with reduced Crohn’s disease risk in individuals with proficient acetaldehyde metabolism, those with high acetaldehyde burden faced increased risk. Genetic, metabolomic, and experimental models corroborate acetaldehyde’s deleterious role and acetate’s protective effects, underscoring the need for tailored prevention approaches.
