期刊
ECLINICALMEDICINE
卷 36, 期 -, 页码 -出版社
ELSEVIER
DOI: 10.1016/j.eclinm.2021.100884
关键词
Inflammatory bowel disease; Crohn's disease; Ulcerative colitis; Early life; Risk factors; Environmental exposure; Non-genetic; Epidemiology
资金
- Dickler Family Fund
- Leona M. and Harry B. Helmsley Charitable Trust
- Fonds Wetenschappelijk Onderzoek
- Helmsley Charitable Trust Fund
- Crohn's and Colitis Foundation
- Judith & Stewart Colton Center for Autoimmunity
- NIH NIDDK Diseases [K23DK124570]
- Veterans Affairs Career Development Award [ICX002027A]
- Digest Science Foundation (Lille, France)
- McMaster University Department of Medicine Internal Career Award
- MELODY trial
- 2019 American Gastroenterological Association Research Scholar Award
- New York Community Trust
Early life exposures can impact the risk of immune-mediated diseases like inflammatory bowel disease, with factors such as prenatal exposure to antibiotics, tobacco smoke, and early otitis media potentially increasing the risk of IBD, while breastfeeding may have a protective effect. Other early life risk factors showed limited and heterogeneous associations with the disease.
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. (C) 2021 The Authors. Published by Elsevier Ltd.
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