Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific
Open accessAbstract
Objective: The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. Design: 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. Results: In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. Conclusions: This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life.
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Inhabitants of these urban environments have been exposed to westernization including diets higher in fat and refined sugars and lifestyle changes such as increased smoking, less breastfeeding, greater antibiotic exposure, and improved hygiene and sanitation.
“Inhabitants in these urban environments have been exposed to westernization of their society including diets containing higher levels of fat and refined sugars and changes in lifestyle behaviours, such as an increase in smoking, less breastfeeding, greater exposure to antibiotics and improved hygiene and sanitation56.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [56]
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- Authors
- Ng, S. C., Tang, W., Leong, R. W., Chen, M., Ko, Y., Studd, C., Niewiadomski, O., Bell, S., Kamm, M. A., de Silva, H. J., Kasturiratne, A., Senanayake, Y. U., Ooi, C. J., Ling, K.-L., Ong, D., Goh, K. L., Hilmi, I., Ouyang, Q., Wang, Y.-F., Hu, P., Zhu, Z., Zeng, Z., Wu, K., Wang, X., Xia, B., Li, J., Pisespongsa, P., Manatsathit, S., Aniwan, S., Simadibrata, M., Abdullah, M., Tsang, S. W. C., Wong, T. C., Hui, A. J., Chow, C. M., Yu, H. H., Li, M. F., Ng, K. K., Ching, J., Wu, J. C. Y., Chan, F. K. L., & Sung, J. J. Y.
- Affiliations
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
- Sun Yat-sen University (CN)
- The University of Melbourne (AU)
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- University of Kelaniya (LK)
- Singapore General Hospital (SG)
- National University Hospital (SG)
- University Malaya Medical Centre (MY)
- Sichuan University (CN)
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
- Xijing Hospital (CN)
- Zhongnan Hospital of Wuhan University (CN)
- Maharaj Nakorn Chiang Mai Hospital (TH)
- Siriraj Hospital (TH)
- King Chulalongkorn Memorial Hospital (TH)
- University of Indonesia, Indonesia, Indonesia
- University of Indonesia (ID)
- Tseung Kwan O Hospital (CN)
- North District Hospital (HK)
- Alice Ho Miu Ling Nethersole Hospital (CN)
- Chinese University of Hong Kong (HK)
- Kiang Wu Hospital (CN)
- Hospital Conde S. Januário (CN)
- Corresponding author
- Ng, Siew C
- ORCID
- Ng, Siew C
- Tang, Whitney
- Leong, Rupert W
- Chen, Minhu
- Ko, Yanna
- Niewiadomski, Ola
- Bell, Sally
- Kamm, Michael A
- Kasturiratne, Anuradhani
- Ooi, Choon Jin
- Ong, David
- Goh, Khean Lee
- Hilmi, Ida
- Ouyang, Qin
- Zhu, Zhenhua
- Zeng, Zhirong
- Wu, Kaichun
- Xia, Bing
- Li, Jin
- Pisespongsa, Pises
- Aniwan, Satimai
- Abdullah, Murdani
- Hui, Aric J
- Chow, Chung Mo
- Yu, Hon Ho
- Ng, Ka Kei
- Wu, Justin C Y
- Chan, Francis K L
- Sung, Joseph J Y
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2014-09-12
- Volume
- 64
- Issue
- 7
- Pages
- 1063-1071
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W2098454283
- Cited by
- 443
- References
- 37
- Citations by year
- 2026: 16 · 2025: 33 · 2024: 46 · 2023: 33 · 2022: 32 · 2021: 41 · 2020: 64 · 2019: 59 · 2018: 30 · 2017: 40 · 2016: 31 · 2015: 13 · 2014: 4
- FWCI
- 19.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Hong Kong
- Chinese University of Hong Kong
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- inflammatory bowel disease, Crohn's disease, ulcerative colitis, environmental risk factors, breastfeeding, antibiotic use, pet ownership, tea consumption, coffee consumption, physical activity, flush toilets, childhood smoking, gut microbiota, hygiene hypothesis, Asian populations, Asia-Pacific region, Australia, Pacific Islands
- MeSH terms
- Adult, Asia, Australia, Breast Feeding, Female, Humans, Intestines, Male, Middle Aged, Prospective Studies, Risk Factors, Smoking, Inflammatory Bowel Diseases, Incidence, Multivariate Analysis, Case-Control Studies, Pets, Microbiota
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