Western diseases: current concepts and implications for pediatric surgery research and practice

Abstract

The term "Western diseases" refers to those conditions that are rare or absent in underdeveloped areas of the Third World and increase in frequency with adoptions of Western customs. In adults, they include such common conditions as coronary artery disease, essential hypertension, appendicitis, cholesterol gall stones, and colon cancer. The best examples of Western diseases in the pediatric population are asthma, allergies, appendicitis, and inflammatory bowel disease. Limited data from sub-Saharan Africa suggest other pediatric surgical conditions may fall into this category, including hypertrophic pyloric stenosis, gastroesophageal reflux, perirectal abscess, anal fissure, gastroschesis, and neuroblastoma. Existing theories for the origins of Western diseases have postulated a role for decreased dietary fiber, improved hygiene, fetal programming, and a protective effect of tropical enteropathy. How these factors might relate to the rise of appendicitis, inflammatory bowel disease, and possibly other common pediatric surgical diseases in industrialized societies remains poorly understood. Further research is needed to better define geographical differences in common pediatric surgical conditions and to investigate how genetic and environmental factors interact to modify risk of disease. Understanding the molecular mechanisms that give rise to Western diseases could lead to new therapeutic and prevention strategies for some of the most common pediatric surgical conditions in industrialized countries.

Immune-directed support of rich microbial communities in the gut has ancient roots

“…The gut ecosystem, the major site of immune detection and response to a potentially overwhelming antigenic load, is failing in its ability to maintain a balance of resistance and tolerance (Rook and Brunet, 2005). The continuous crosstalk that has evolved between the immune system and the microbiome is breaking down, as is the closely associated development of host immunity (Bickler and DeMaio, 2008). To a significant extent, the root cause of these immune problems can be traced to a protracted history of concern about infectious agents, which has reinforced the traditional (and overly simplistic) view that the immune system is more of a defense system than an interface with the environment.…”

Evolutionary biology and anthropology suggest biome reconstitution as a necessary approach toward dealing with immune disorders

“…Diseases such as hay fever and food allergies, which were not described prior to 1800 and which are not found in today’s developing societies [3], are now commonplace in the USA, the UK and in other industrialized countries. With as much as 40% of the US population suffering from allergic disorders [4, 5], and another 2–8% facing autoimmune conditions [6], modern medicine has thus far failed to contain the onslaught of non-infectious, immune-related pandemics.…”

Diet-Induced Metabolic Improvements in a Hamster Model of Hypercholesterolemia Are Strongly Linked to Alterations of the Gut Microbiota

“…Coronary heart disease (CHD) continues to be a major cause of death in developed countries and is another example of a "western disease" that is less common in underdeveloped countries but increases in frequency with adoption of western customs (4). Most risk factors for CHD (obesity, high blood pressure, type 2 diabetes, heredity, high cholesterol, and diet) have been linked to the gut microbiota (7,17,20,30,45), and gut bacteria have been suggested to play a role in the etiology of cardiovascular disease (16,33).…”