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Study Identifies Childhood Immunological, Hygiene, Dietary Risk Factors for IBD in Asia-Pacific
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An Asian-Pacific population-based study identified immunological, hygiene and dietary factors in childhood were associated with increased risk for developing inflammatory bowel disease.
As part of the Asia-Pacific Crohn’s and Colitis Epidemiology study (ACCESS), researchers performed a prospective, population-based, case-control study of risk factors prior to the development of IBD in patients from China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, Thailand and Australia.
Overall, 442 IBD patients (58% ulcerative colitis; 42% Crohn’s disease) diagnosed from 2011 to 2013 and 940 controls (matched for age, gender, ethnicity and location) completed a questionnaire from the International Organization of IBD on environmental factors. The majority of participants were Asian, and the questionnaire — which assessed childhood factors, food habits before diagnosis, smoking habits, sanitary conditions and other factors — was completed within 4 weeks of diagnosis.
Multivariate analyses revealed protective factors against developing Crohn’s disease in Asians included:
- being breast-fed for a year or longer (adjusted OR = 0.1; 95% CI, 0.04-0.3);
- antibiotic use before age 15 years (aOR = 0.19; 95% CI, 0.07-0.52);
- having dogs during childhood (aOR = 0.54; 95% CI, 0.35-0.83);
- drinking tea daily (aOR = 0.62; 95% CI, 0.43-0.91); and
- engaging in daily physical activity (aOR = 0.58; 95% CI, 0.35-0.96).
Breast-feeding, antibiotic use, having dogs and drinking tea also had a protective effect against Crohn’s disease in Australians.
Protective factors against developing ulcerative colitis in Asians included:
- being breast-fed for a year or longer (aOR = 0.16; 95% CI, 0.08-0.31);
- antibiotic use in childhood (aOR = 0.48; 95% CI, 0.27-0.87);
- having aquarium fish (aOR = 0.46; 95% CI, 0.29-0.73);
- drinking tea daily (aOR = 0.63; 95% CI, 0.46-0.86);
- drinking coffee daily (aOR = 0.51; 95% CI, 0.36-0.72);
- having in-house water tap during childhood (aOR = 0.67; 95% CI, 0.48-0.93);
- having hot water tap during childhood (aOR = 0.65; 95% CI, 0.46-0.91); and
- having a flush toilet during childhood (aOR = 0.71; 95% CI, 0.51-0.98).
Breast feeding, antibiotic use, having aquarium fish, having a hot water tap or having a flush toilet also had a protective effect against ulcerative colitis in Australians.
Combined analysis of both Asians and Australians showed bacille Calmette-Guérin tuberculosis vaccine increased risk for Crohn’s disease (aOR = 2.14; 95% CI, 1.03-4.42), but pertussis vaccine decreased risk for ulcerative colitis (aOR = 0.61; 95% CI, 0.38-0.99).
Smoking increased risk for developing Crohn’s disease by more than four times in Australians (aOR = 4.3; 95% CI, 1.22-15.16), and ex-smoking increased risk for ulcerative colitis in both Asians (aOR = 2.02; 95% CI, 1.22-3.35) and Australians (aOR = 3.73; 95% CI, 1.14-12.16).
“In conclusion, we reported for the first time in a population-based cohort in Asia-Pacific the role of dietary and immunological alterations early in life and development of IBD,” the researchers wrote. Crohn’s disease and ulcerative colitis “share overlapping environmental factors. We found a duration-response protective association between breast feeding and disease development, and contact with childhood pets is a novel protective factor. These observed associations indicate that early childhood factors and markers of altered intestinal microbiota including antibiotic use may modulate the risk of IBD later in life and that this period requires further evaluation.”
Johan Burisch
“These are the first large prospective data on environmental factors from Asia, which, surprisingly, are in concordance with data reported previously from Caucasian populations from Western Europe and North America,” Peter Laszlo Lakatos, MD, from Semmelweis University in Hungary, and Johan Burisch, MD, from Hvidovre University Hospital in Denmark, wrote in a related editorial. “The study has several advantages,” including its design, vigorous matching of controls and use of a questionnaire used frequently in previous studies.
“On the other hand, the study of environmental factors in such a setting is a treacherous path,” they wrote. “The … questionnaire has never been validated” and may not perform well across different environments; some “potentially important questions” were omitted; the interpretation of questions may have been culturally variable; the country-level data are small and national or ethnic variation may be undetectable; and the combination of Asian and Australian data, as well as their prediction based on first-year incidence data “that the authors were only able to include approximately 50%-55% of the incident cases” may introduce biases. – by Adam Leitenberger
Disclosure: The researchers, Lakatos and Burisch report no relevant financial disclosures.
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