The Association between Childhood Environmental Exposures and the Subsequent Development of Crohn's Disease in the Western Cape, South Africa

Basson, Abigail R.; Swart, Rina; Jordaan, Esmè; Mazinu, Mikateko; Watermeyer, Gillian

doi:10.1371/journal.pone.0115492

Cited by 12 publications

(18 citation statements)

References 25 publications

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“…Nine examined exposure during infancy early childhood and 8 included non-white populations 13, 20-22, 24, 26 . The included literature comprised 5,391 cases of CD, 2,504 of UC, and 179 with IBD.…”

Section: Resultsmentioning

confidence: 99%

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Environmental Hygiene and Risk of Inflammatory Bowel Diseases

Cholapranee

Ananthakrishnan

2016

Inflammatory Bowel Diseases

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Background According to the hygiene hypothesis, individuals raised in a sanitary environment have a higher risk of developing inflammatory bowel diseases (IBD). However, results have been inconsistent. We conducted this systematic review of factors related to environmental hygiene and risk of IBD, Crohn's disease (CD) and ulcerative colitis (UC). Methods A systematic search was performed on MEDLINE between 1980-2015 to identify studies of the association between IBD and contact with pets and farm animals, number of siblings, bedroom sharing in childhood, access to personal toilet and hot water. Random or fixed effect meta-analyses were performed, and analysis further stratified based on ethnicity of the included cohort. Results A total of 29 relevant studies were included. Having a pet (Odds Ratio (OR) 0.76, 95% confidence interval (CI) 0.63 – 0.88) and contact with farm animals was inversely associated with risk of IBD (OR 0.45, 95% CI 0.31 – 0.60). However, the strength of association with farm animals was statistically stronger in non-white cohorts (OR 0.27, 95% CI 0.02 – 0.53) than white cohorts (OR 0.55, 95% CI 0.45 – 0.65) (p=0.028). Access to toilet (OR 0.71, 95% CI 0.56 – 0.85) and hot water (OR 0.67, 95% CI 0.44 – 0.89) was inversely associated with UC in non-white populations but not Caucasians. Having more than 2 siblings was inversely associated with risk of CD. Conclusions Several factors pertaining to reduced environmental hygiene are inversely associated with risk of IBD. However, underlying ethnicity influences susceptibility to the effect of these factors.

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Section: Resultsmentioning

confidence: 99%

“…A total of 10, 8, and 3 studies provided information on association between home or bedroom sharing and CD, UC, or IBD respectively (Table 1) 12, 13, 15, 19, 20, 24, 28-32 . Five examined exposure during early childhood and six were in a non-white population.…”

Section: Resultsmentioning

confidence: 99%

Environmental Hygiene and Risk of Inflammatory Bowel Diseases

Cholapranee

Ananthakrishnan

2016

Inflammatory Bowel Diseases

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“…Disease characteristics of the CD cohort have been described in detail elsewhere [26]. Healthy controls, not related to the CD cases, were identified from the same populations giving rise to the CD cases; the recruitment method for control subjects has been described elsewhere [27].…”

Section: Design and Settingmentioning

confidence: 99%

Vitamin D Deficiency Increases the Risk for Moderate to Severe Disease Activity in Crohn's Disease Patients in South Africa, Measured by the Harvey Bradshaw Index

Basson

Swart²,

Jordaan

et al. 2015

Journal of the American College of Nutrition

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“…In a second report, the same authors identified a significant risk-association between second-hand cigarette smoke exposure during childhood (0–5 and 11–18 years) and risk of future CD development. Moreover, an exposure to second-hand cigarette smoke during the age interval 11–18 years, was found to be independently associated with CD risk [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Second-Hand Cigarette Smoke Exposure during Childhood and Active Cigarette Smoking on Crohn’s Disease Phenotype Defined by the Montreal Classification Scheme in a Western Cape Population, South Africa

2015

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BackgroundSmoking may worsen the disease outcomes in patients with Crohn’s disease (CD), however the effect of exposure to second-hand cigarette smoke during childhood is unclear. In South Africa, no such literature exists. The aim of this study was to investigate whether disease phenotype, at time of diagnosis of CD, was associated with exposure to second-hand cigarette during childhood and active cigarette smoking habits.MethodsA cross sectional examination of all consecutive CD patients seen during the period September 2011-January 2013 at 2 large inflammatory bowel disease centers in the Western Cape, South Africa was performed. Data were collected via review of patient case notes, interviewer-administered questionnaire and clinical examination by the attending gastroenterologist. Disease phenotype (behavior and location) was evaluated at time of diagnosis, according to the Montreal Classification scheme. In addition, disease behavior was stratified as ‘complicated’ or ‘uncomplicated’, using predefined definitions. Passive cigarette smoke exposure was evaluated during 3 age intervals: 0–5, 6–10, and 11–18 years.ResultsOne hundred and ninety four CD patients were identified. Cigarette smoking during the 6 months prior to, or at time of diagnosis was significantly associated with ileo-colonic (L3) disease (RRR = 3.63; 95%CI, 1.32–9.98, p = 0.012) and ileal (L1) disease (RRR = 3.54; 95%CI, 1.06–11.83, p = 0.040) compared with colonic disease. In smokers, childhood passive cigarette smoke exposure during the 0–5 years age interval was significantly associated with ileo-colonic CD location (RRR = 21.3; 95%CI, 1.16–391.55, p = 0.040). No significant association between smoking habits and disease behavior at diagnosis, whether defined by the Montreal scheme, or stratified as ‘complicated’ vs ‘uncomplicated’, was observed.ConclusionSmoking habits were associated with ileo-colonic (L3) and ileal (L1) disease at time of diagnosis in a South African cohort.

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The Association between Childhood Environmental Exposures and the Subsequent Development of Crohn's Disease in the Western Cape, South Africa

Cited by 12 publications

References 25 publications

Environmental Hygiene and Risk of Inflammatory Bowel Diseases

Environmental Hygiene and Risk of Inflammatory Bowel Diseases

Vitamin D Deficiency Increases the Risk for Moderate to Severe Disease Activity in Crohn's Disease Patients in South Africa, Measured by the Harvey Bradshaw Index

The Influence of Second-Hand Cigarette Smoke Exposure during Childhood and Active Cigarette Smoking on Crohn’s Disease Phenotype Defined by the Montreal Classification Scheme in a Western Cape Population, South Africa

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