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Weidner J, Glauche I, Manuwald U, Kern I, Reinecke I, Bathelt F, Amin M, Dong F, Rothe U, Kugler J. Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression. JMIR Public Health Surveill 2024; 10:e48682. [PMID: 38526534 PMCID: PMC11002755 DOI: 10.2196/48682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. OBJECTIVE This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. METHODS We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. RESULTS A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. CONCLUSIONS Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-037669.
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Affiliation(s)
- Jens Weidner
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ulf Manuwald
- Faculty of Applied Social Sciences, University of Applied Sciences (FHD), Dresden, Germany
| | - Ivana Kern
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Bathelt
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Thiem-Research GmbH, Cottbus, Germany
| | - Makan Amin
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department for Trauma Surgery and Orthopaedics, Park-Klinik Weissensee, Berlin, Germany
| | - Fan Dong
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Joachim Kugler
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Lee WS, Song ZL, Wong SY, Gan CW, Koay ZL, Em JM, Chong SY, Lim CB, Wong SY, Chew KS, Kam CC. Environmental risk factors for inflammatory bowel disease: A case control study in Southeast Asian children. J Paediatr Child Health 2022; 58:782-790. [PMID: 34761458 DOI: 10.1111/jpc.15830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
AIM Early-life environmental exposure, which has important implications in the pathogenesis of inflammatory bowel disease (IBD), is not well understood in Asian children. We examined environmental factors prior to the development of childhood IBD in a Southeast Asian population. METHODS We conducted a case control study in IBD diagnosed before 18 years of age and controls matched by gender, age and ethnicity. A questionnaire recording medical, family, dietary and social histories, home environment, childhood diseases and immunisation status was used. RESULTS In a multivariate analysis involving 70 children with IBD (Crohn's disease (CD) = 38; ulcerative colitis (UC) = 32) and 140 controls, childhood acute gastroenteritis (odds ratio (OR): IBD 6.9; CD 7.8; UC 5.8) and excessive antibiotic usage in early childhood (OR: IBD 5.3; CD 4.2; UC 4.8) were significantly associated with IBD, CD and UC. Having a fish or turtle aquarium (OR 6.0), major stressful life events (OR 5.6) and attending the same school concurrently with a sibling (OR 2.9) were significant risk factors for IBD. Duration of breastfeeding >6 months (OR: IBD 0.4; UC 0.2) and safe water consumption (OR: IBD 0.2; UC 0.2) reduced the odds of having IBD and UC, respectively. Being vaccinated for rotavirus reduced the odds of developing IBD (OR 0.1). CONCLUSIONS Several risk and protective factors were identified in this environmental risk study in Southeast Asian children with IBD. This knowledge has important implications in understanding disease aetiology and future prevention strategies to reduce the development of IBD in Southeast Asian children.
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Affiliation(s)
- Way S Lee
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.,Paediatrics and Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Zhi L Song
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Sean Y Wong
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Chai W Gan
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Zhong L Koay
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Jun M Em
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Sze Y Chong
- Paediatric Unit, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Chooi B Lim
- Paediatric Unit, Selayang Hospital, Selangor, Malaysia
| | - Shin Y Wong
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Kee S Chew
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Choy C Kam
- Paediatric Unit, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
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3
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Miller KM, Hart PH, Lucas RM, Davis EA, de Klerk NH. Higher ultraviolet radiation during early life is associated with lower risk of childhood type 1 diabetes among boys. Sci Rep 2021; 11:18597. [PMID: 34545118 PMCID: PMC8452739 DOI: 10.1038/s41598-021-97469-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
Population-level ecological studies show type 1 diabetes incidence is inversely correlated with ambient ultraviolet radiation (UVR) levels. We conducted a nested case-control study using administrative datasets to test this association at the individual level. Cases (n = 1819) were children born in Western Australia (WA) from 1980-2014, diagnosed with type 1 diabetes at ≤ 16 years. Controls (n = 27,259) were randomly selected from all live births in WA, matched to cases by sex and date of birth. Total ambient erythemal ultraviolet radiation (UVR) doses for each trimester of pregnancy and first year of life were estimated for each individual, using daily NASA satellite data that were date- and geographically-specific. Conditional logistic regression tested the association between UVR dose and case-control status. Type 1 diabetes risk was 42% lower in boys of mothers with third-trimester UVR dose in the highest (compared to the lowest) quartile (p = 0.04). Higher UVR in the first year of life was associated with lower type 1 diabetes risk among boys (p = 0.01). UVR dose was not associated with type 1 diabetes risk in girls. Higher UVR in late pregnancy and early life appear to interact with sex-specific factors to lower type 1 diabetes risk among boys in Western Australia.
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Affiliation(s)
- Kate M. Miller
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Nedlands, 6009 Australia
| | - Prue H. Hart
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Nedlands, 6009 Australia
| | - Robyn M. Lucas
- grid.1001.00000 0001 2180 7477National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australian Capital Territory, 0200 Australia
| | - Elizabeth A. Davis
- grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Nedlands, 6009 Australia
| | - Nicholas H. de Klerk
- grid.1012.20000 0004 1936 7910University of Western Australia, Crawley, 6009 Australia
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4
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Agrawal M, Sabino J, Frias-Gomes C, Hillenbrand CM, Soudant C, Axelrad JE, Shah SC, Ribeiro-Mourão F, Lambin T, Peter I, Colombel JF, Narula N, Torres J. Early life exposures and the risk of inflammatory bowel disease: Systematic review and meta-analyses. EClinicalMedicine 2021; 36:100884. [PMID: 34308303 PMCID: PMC8257976 DOI: 10.1016/j.eclinm.2021.100884] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Early life exposures impact immune system development and therefore the risk of immune-mediated diseases, including inflammatory bowel disease (IBD). We systematically reviewed the impact of pre-, peri‑, and postnatal exposures up to the age of five years on subsequent IBD diagnosis. METHODS We identified case-control and cohort studies reporting on the association between early life environmental factors and Crohn's disease (CD), ulcerative colitis (UC), or IBD overall. Databases were search from their inception until May 24th, 2019 until July 14th, 2020. We conducted meta-analyses for quantitative review of relevant risk factors that were comparable across studies and qualitative synthesis of the literature for a wide range of early life exposures, including maternal health and exposures during pregnancy, perinatal factors, birth month and related-factors, breastfeeding, hygiene-related factors and social factors, immigration, antibiotics, offspring health, including infections, and passive smoking. PROSPERO registration: CRD42019134980. FINDINGS Prenatal exposure to antibiotics (OR 1.8; 95% CI 1.2-2.5) and tobacco smoke (OR 1.5; 95% CI 1.2-1.9), and early life otitis media (OR 2.1; 95% CI 1.2-3.6) were associated with IBD. There was a trend towards an association between exposure to antibiotics in infancy and IBD (OR: 1.7, 95% CI 0.97, 2.9), supported by positive data on population-based data. Breastfeeding was protective against IBD. Other early life risk factors had no association with IBD, but data were limited and heterogenous. INTERPRETATION Early life is an important period of susceptibility for IBD development later in life. Tobacco smoke, infections and antibiotics were associated positively, and breastfeeding was associated negatively with IBD. Our findings offer an opportunity to develop primary prevention strategies. FUNDING This study did not receive any funding.
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Affiliation(s)
- Manasi Agrawal
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - João Sabino
- Gastroenterology Division, University Hospital of Leuven, Leuven, Belgium
| | - Catarina Frias-Gomes
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures 2674-514, Portugal
| | - Christen M. Hillenbrand
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Celine Soudant
- Levy Library, The Mount Sinai Medical Center, New York, NY, United States
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jordan E. Axelrad
- Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, United States
| | - Shailja C. Shah
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, United States
- Section of Gastroenterology, Veterans Affairs Tennessee Valley Healthcare System, Nashville campus, Nashville, TN, United States
| | - Francisco Ribeiro-Mourão
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
- Pediatrics Department, Centro Materno Infantil do Norte – Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Thomas Lambin
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille, Lille, France
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive, Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Joana Torres
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures 2674-514, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Portugal
- Corresponding author.
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5
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Neale RE, Barnes PW, Robson TM, Neale PJ, Williamson CE, Zepp RG, Wilson SR, Madronich S, Andrady AL, Heikkilä AM, Bernhard GH, Bais AF, Aucamp PJ, Banaszak AT, Bornman JF, Bruckman LS, Byrne SN, Foereid B, Häder DP, Hollestein LM, Hou WC, Hylander S, Jansen MAK, Klekociuk AR, Liley JB, Longstreth J, Lucas RM, Martinez-Abaigar J, McNeill K, Olsen CM, Pandey KK, Rhodes LE, Robinson SA, Rose KC, Schikowski T, Solomon KR, Sulzberger B, Ukpebor JE, Wang QW, Wängberg SÅ, White CC, Yazar S, Young AR, Young PJ, Zhu L, Zhu M. Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, Update 2020. Photochem Photobiol Sci 2021; 20:1-67. [PMID: 33721243 PMCID: PMC7816068 DOI: 10.1007/s43630-020-00001-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
This assessment by the Environmental Effects Assessment Panel (EEAP) of the United Nations Environment Programme (UNEP) provides the latest scientific update since our most recent comprehensive assessment (Photochemical and Photobiological Sciences, 2019, 18, 595-828). The interactive effects between the stratospheric ozone layer, solar ultraviolet (UV) radiation, and climate change are presented within the framework of the Montreal Protocol and the United Nations Sustainable Development Goals. We address how these global environmental changes affect the atmosphere and air quality; human health; terrestrial and aquatic ecosystems; biogeochemical cycles; and materials used in outdoor construction, solar energy technologies, and fabrics. In many cases, there is a growing influence from changes in seasonality and extreme events due to climate change. Additionally, we assess the transmission and environmental effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the COVID-19 pandemic, in the context of linkages with solar UV radiation and the Montreal Protocol.
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Affiliation(s)
- R E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - P W Barnes
- Biological Sciences and Environmental Program, Loyola University New Orleans, New Orleans, LA, USA
| | - T M Robson
- Organismal and Evolutionary Biology (OEB), Viikki Plant Sciences Centre (ViPS), University of Helsinki, Helsinki, Finland
| | - P J Neale
- Smithsonian Environmental Research Center, Maryland, USA
| | - C E Williamson
- Department of Biology, Miami University, Oxford, OH, USA
| | - R G Zepp
- ORD/CEMM, US Environmental Protection Agency, Athens, GA, USA
| | - S R Wilson
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - S Madronich
- Atmospheric Chemistry Observations and Modeling Laboratory, National Center for Atmospheric Research, Boulder, CO, USA
| | - A L Andrady
- Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC, USA
| | - A M Heikkilä
- Finnish Meteorological Institute, Helsinki, Finland
| | - G H Bernhard
- Biospherical Instruments Inc, San Diego, CA, USA
| | - A F Bais
- Department of Physics, Laboratory of Atmospheric Physics, Aristotle University, Thessaloniki, Greece
| | - P J Aucamp
- Ptersa Environmental Consultants, Pretoria, South Africa
| | - A T Banaszak
- Unidad Académica de Sistemas Arrecifales, Universidad Nacional Autónoma de México, Puerto Morelos, México
| | - J F Bornman
- Food Futures Institute, Murdoch University, Perth, Australia.
| | - L S Bruckman
- Department of Materials Science and Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - S N Byrne
- The University of Sydney, School of Medical Sciences, Discipline of Applied Medical Science, Sydney, Australia
| | - B Foereid
- Environment and Natural Resources, Norwegian Institute of Bioeconomy Research, Ås, Norway
| | - D-P Häder
- Department of Biology, Friedrich-Alexander University, Möhrendorf, Germany
| | - L M Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - W-C Hou
- Department of Environmental Engineering, National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - S Hylander
- Centre for Ecology and Evolution in Microbial model Systems-EEMiS, Linnaeus University, Kalmar, Sweden.
| | - M A K Jansen
- School of BEES, Environmental Research Institute, University College Cork, Cork, Ireland
| | - A R Klekociuk
- Antarctic Climate Program, Australian Antarctic Division, Kingston, Australia
| | - J B Liley
- National Institute of Water and Atmospheric Research, Lauder, New Zealand
| | - J Longstreth
- The Institute for Global Risk Research, LLC, Bethesda, MD, USA
| | - R M Lucas
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - J Martinez-Abaigar
- Faculty of Science and Technology, University of La Rioja, Logroño, Spain
| | | | - C M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K K Pandey
- Department of Wood Properties and Uses, Institute of Wood Science and Technology, Bangalore, India
| | - L E Rhodes
- Photobiology Unit, Dermatology Research Centre, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - S A Robinson
- Securing Antarctica's Environmental Future, Global Challenges Program and School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - K C Rose
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - T Schikowski
- IUF-Leibniz Institute of Environmental Medicine, Dusseldorf, Germany
| | - K R Solomon
- Centre for Toxicology, School of Environmental Sciences, University of Guelph, Guelph, Canada
| | - B Sulzberger
- Academic Guest Eawag: Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - J E Ukpebor
- Chemistry Department, Faculty of Physical Sciences, University of Benin, Benin City, Nigeria
| | - Q-W Wang
- Institute of Applied Ecology, Chinese Academy of Sciences (CAS), Shenyang, China
| | - S-Å Wängberg
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | - C C White
- Bee America, 5409 Mohican Rd, Bethesda, MD, USA
| | - S Yazar
- Garvan Institute of Medical Research, Sydney, Australia
| | - A R Young
- St John's Institute of Dermatology, King's College London, London, UK
| | - P J Young
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - L Zhu
- Center for Advanced Low-Dimension Materials, Donghua University, Shanghai, China
| | - M Zhu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Donghua University, Shanghai, China
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6
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Glapa-Nowak A, Szczepanik M, Kwiecień J, Szaflarska-Popławska A, Flak-Wancerz A, Iwańczak B, Osiecki M, Kierkuś J, Pytrus T, Lebensztejn D, Banasiewicz T, Banaszkiewicz A, Walkowiak J. Insolation and Disease Severity in Paediatric Inflammatory Bowel Disease-A Multi-Centre Cross-Sectional Study. J Clin Med 2020; 9:jcm9123957. [PMID: 33297324 PMCID: PMC7762204 DOI: 10.3390/jcm9123957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 12/19/2022] Open
Abstract
This study was to investigate whether the clinical course of inflammatory bowel disease (IBD) in a Polish paediatric cohort fits a seasonal pattern and depends on insolation. Two hundred and fourteen patients diagnosed with Crohn's disease (CD) and 192 with ulcerative colitis (UC) aged from 3 to 18 years, were recruited in seven centres of similar latitude. The seasons were defined as winter (December-February), spring (March-May), summer (June-August), autumn (September-November). The year was also divided depending on insolation threshold (3.0 kWh/m2/day). Patients diagnosed with IBD when the isolation was >3 kWh/m2/day had poorer nutritional status than those diagnosed while insolation was below threshold (lower standardised BMI at diagnosis (-0.81 ([-1.34]-[-0.03]) vs. -0.52 ([-1.15]-0.15); p = 0.0320) and worst flare (-0.93 ([-1.37]-[-0.05]) vs. -0.66 ([-1.23]-0.17); p = 0.0344), with the need for more frequent biological treatment (45.5% vs. 32.7%, p = 0.0100). Patients diagnosed in winter were significantly younger at diagnosis (11.4 vs. 13.0; padj = 0.0180) and first immunosuppressive treatment (11.3 vs. 13.3; padj = 0.0109) than those diagnosed in other seasons. CD patients diagnosed in months with higher insolation spent more days in hospital than those diagnosed in months with lower insolation [4.6 (1.8-11.8) vs. 2.9 (1.3-6.2); p = 0.0482]. CD patients diagnosed in summer had significantly more concomitant diseases. In patients with CD, the occurrence of the worst flare was more frequent in autumn. Furthermore, the season of birth was associated with Pediatric Crohn's Disease Activity Index at worst flare and earlier surgery. In conclusion, several clinical parameters are associated with insolation, the season of diagnosis and season of birth in the clinical course of Crohn's disease.
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Affiliation(s)
- Aleksandra Glapa-Nowak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, 60-572 Poznan, Poland; (A.G.-N.); (M.S.)
| | - Mariusz Szczepanik
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, 60-572 Poznan, Poland; (A.G.-N.); (M.S.)
| | - Jarosław Kwiecień
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland;
| | - Anna Szaflarska-Popławska
- Department of Pediatric Endoscopy and Gastrointestinal Function Testing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
| | - Anna Flak-Wancerz
- Department of Pediatrics, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Barbara Iwańczak
- Department and Clinic of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, 50-369 Wroclaw, Poland; (B.I.); (T.P.)
| | - Marcin Osiecki
- The Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.O.); (J.K.)
| | - Jarosław Kierkuś
- The Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.O.); (J.K.)
| | - Tomasz Pytrus
- Department and Clinic of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, 50-369 Wroclaw, Poland; (B.I.); (T.P.)
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, 15-274 Bialystok, Poland;
| | - Tomasz Banasiewicz
- Department of General and Endocrine Surgery and Gastroenterological Oncology, Poznań University of Medical Sciences, 60-355 Poznan, Poland;
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, 60-572 Poznan, Poland; (A.G.-N.); (M.S.)
- Correspondence:
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7
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Ivković L, Hojsak I, Trivić I, Sila S, Hrabač P, Konjik V, Senečić-Čala I, Palčevski G, Despot R, Žaja O, Kolaček S. Incidence and Geographical Variability of Pediatric Inflammatory Bowel Disease in Croatia: Data From the Croatian National Registry for Children With Inflammatory Bowel Disease. Clin Pediatr (Phila) 2020; 59:1182-1190. [PMID: 32674589 DOI: 10.1177/0009922820941202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to determine the annual incidence and geographic distribution of pediatric inflammatory bowel disease (IBD) in Croatia. This is a prospective, cohort, multicenter observational study based on the data obtained from the Croatian national registry for children with IBD. Children and adolescents younger than 18 years diagnosed with IBD, in time period between June 1, 2016, and May 31, 2017, were recruited. In total, 51 new cases were identified; 19 Crohn's disease, 28 ulcerative colitis, and 8 IBD-unclassified. Male preponderance of all 3 types of the disease was noticed. The median age at diagnosis was 14.8 years. The calculated annual incidence of pediatric IBD per 100 000 persons per year was 7.05 (2.63 for Crohn's disease, 3.87 for ulcerative colitis, and 0.55 for IBD-unclassified). A north to south gradient was observed with almost 2 times higher incidence in the northern region of the country.
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Affiliation(s)
| | - Iva Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia.,University of Zagreb, Zagreb, Croatia.,University J. J. Strossmayer, Osijek, Croatia
| | | | - Sara Sila
- Children's Hospital Zagreb, Zagreb, Croatia
| | | | | | | | | | - Ranka Despot
- University Hospital Center Split, Split, Croatia
| | - Orjena Žaja
- University Hospital Sisters of Mercy, Zagreb, Croatia
| | - Sanja Kolaček
- Children's Hospital Zagreb, Zagreb, Croatia.,University of Zagreb, Zagreb, Croatia
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Szilagyi A, Smith BE, Sebbag N, Leighton H, Xue X. Changing Patterns of Relationships Between Geographic Markers and IBD: Possible Intrusion of Obesity. CROHN'S & COLITIS 360 2020; 2:otaa044. [PMID: 36777297 PMCID: PMC9802469 DOI: 10.1093/crocol/otaa044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background Latitude and lactase digestion status influence incidence and prevalence rates of some noncommunicable diseases. Latitudinal correlations helped define beneficial roles of vitamin D in many diseases like inflammatory bowel disease (IBD). In view of recent global expansion of IBD and population migrations, we reexamine relations with these markers. As these changes also paralleled the pandemic of obesity, we explore possible interactions with IBD. Methods We undertook a literature review to compare rates of obesity, Crohn's disease and ulcerative colitis with the geographic markers of lactase digestion status, average population-weighted national latitude, and national yearly sunshine exposure. Pearson correlations were used throughout to determine r correlation factors. Statistical significance was accepted at P <0.05 using 2-tailed tests. Results Forty-seven countries were matched with various data sets that could be analyzed (range of availability was 49%-85%). While global correlations of IBD with latitude and lactase status remain similar to previous analyses, in Europe and Asia, outcomes were different. Global outcome contains a statistical paradox related to combining countries from Europe and Asia. Obesity showed moderate global correlations with IBD but weak and negligible correlations in Europe and Asia. There was also a weak global correlation with latitude. Conclusions It is suggested that global correlations point to parallel geographic spread of IBD and obesity. The lack of latitudinal relations with obesity suggests reduced vitamin D effect. The paradox supports epidemiological differences in western and eastern IBD. Obesity combined with IBD may contribute to different relations, partly due to variable vitamin D effects.
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Affiliation(s)
- Andrew Szilagyi
- Department of Medicine, Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, QC, Canada,Address correspondence to: A. Szilagyi, MD, 3755 Cote St. Catherine, Montreal, QC, H3T 1E2 ()
| | - Brian E Smith
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
| | - Natanel Sebbag
- School of Medicine, McGill University, Montreal, QC, Canada
| | - Henry Leighton
- Department of Atmospheric and Oceanic Sciences, McGill University, Montreal, QC, Canada
| | - Xiaoqing Xue
- Department of Emergency Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Brenner E, Sylvester FA. To Prevent Inflammatory Bowel Disease in Children, Let the Sunshine in? J Pediatr Gastroenterol Nutr 2019; 69:137. [PMID: 31343486 DOI: 10.1097/mpg.0000000000002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Erica Brenner
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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