Early life environment and natural history of inflammatory bowel diseases

Abstract

BackgroundEarly life exposures may modify risk of inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)). However, the relationship between early life exposures and natural history of IBD has not been previously examined.MethodsThis single center study included patients with CD or UC recruited in a prospective IBD registry. Enrolled patients completed a detailed environmental questionnaire that assessed various early life environmental exposures. Our primary outcome was requirement for disease-related surgery in CD and UC. Logistic regression models defined independent effect of early life exposures, adjusting for potential confounders.ResultsOur study included 333 CD and 270 UC patients. Just over half were female with a median age at diagnosis of 25 years. One-third of the cohort had history of bowel surgery (31%) and nearly half had used at least one biologic agent (47%). Among those with CD, being breastfed was associated with reduced risk of CD-related surgery (34% vs. 55%), while childhood cigarette smoke exposure was associated with increased risk. On multivariate analysis, history of being breastfed (odds ratio (OR) 0.21, 95% confidence interval [CI] 0.09–0.46) and cigarette smoke exposure as a child (OR 2.17, 95% CI 1.10–4.29) remained independently associated with surgery. None of the early life variables influenced disease phenotype or outcome in UC.ConclusionA history of being breastfed was associated with a decreased risk while childhood cigarette smoke exposure was associated with an increased risk of surgery in patients with CD. Further investigation to examine biological mechanisms is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-014-0216-8) contains supplementary material, which is available to authorized users.

Interaction between smoking and ATG16L1T300A triggers Paneth cell defects in Crohn’s disease

“…In addition, while we have previously shown that Paneth cell defects are induced in hypomorphic Atg16l1 mice after MNV infection, we are unable to yet identify such a link in CD patients (21). Even so, smoking is a clinically relevant environmental trigger (23,47). We show that the combination of relevant host genetic and environmental factors can provide insight into disease pathogenesis and therapeutic targets, as has been recently demonstrated in studies such as those of nonalcoholic fatty liver disease (48,49).…”

ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease

“…Comparable data were reported from a Danish cohort study, in which breastfeeding for more than six months decreased the odds of IBD (OR 0.50, 95%CI 0.23e1.11) [11]. Two further publications confirmed this relationship, one from the US and another from Asia-Pacific [12,13]. Breastfeeding for around six months or longer is desirable in all infants [14].…”

The Search for Causative Environmental Factors in Inflammatory Bowel Disease

“…Both factors indicate that hormonal influences also may play a role at least for the risk of disease flares. • For breastfeeding, conflicting results have been reported [20,[67][68][69][70][71] . A meta-analysis could not conclusively decide whether there is a protective or even diseaseaggravating effect [72] .…”