TY - JOUR
T1 - The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children
AU - Lindoso, Livia
AU - Mondal, Kajari
AU - Venkateswaran, Suresh
AU - Somineni, Hari K.
AU - Ballengee, Cortney
AU - Walters, Thomas D.
AU - Griffiths, Anne
AU - Noe, Joshua D.
AU - Crandall, Wallace
AU - Snapper, Scott
AU - Rabizadeh, Shervin
AU - Rosh, Joel R.
AU - LeLeiko, Neal
AU - Guthery, Stephen
AU - Mack, David
AU - Kellermayer, Richard
AU - Gulati, Ajay S.
AU - Pfefferkorn, Marian D.
AU - Moulton, Dedrick E.
AU - Keljo, David
AU - Cohen, Stanley
AU - Oliva-Hemker, Maria
AU - Heyman, Melvin B.
AU - Otley, Anthony
AU - Baker, Susan S.
AU - Evans, Jonathan S.
AU - Kirschner, Barbara S.
AU - Patel, Ashish S.
AU - Ziring, David
AU - Stephens, Michael C.
AU - Baldassano, Robert
AU - Dubinsky, Marla C.
AU - Markowitz, James
AU - Denson, Lee A.
AU - Hyams, Jeffrey
AU - Kugathasan, Subra
AU - Ananthakrishnan, Ashwin N.
N1 - Publisher Copyright:
© 2018, American College of Gastroenterology.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Objectives: Environmental factors play an important role in the pathogenesis of Crohn’s Disease (CD). In particular, by virtue of the instability of the microbiome and development of immunologic tolerance, early life factors may exert the strongest influence on disease risk and phenotype. Methods: We used data from 1119 CD subjects recruited from RISK inception cohort to examine the impact of early life environment on disease progression. Our primary exposures of interest were breastfeeding in infancy and exposure to maternal, active, or passive smoke. Our primary outcomes were development of complicated (stricturing or penetrating) disease, and need for CD-related hospitalization, and surgery. Multivariable logistic regression models were used to define independent associations, adjusting for relevant covariates. Results: Our study cohort included 1119 patients with CD among whom 15% had stricturing (B2) or penetrating disease (B3) by 3 years. 331 patients (35%) and 95 patients (10.6%) required CD-related hospitalizations and surgery respectively. 74.5% were breastfed in infancy and 31% were exposed to smoking among whom 7% were exposed to maternal smoke. On multivariable analysis, a history of breastfeeding was inversely associated with complicated (B2/B3 disease) 0.65, CI 95% 0.44–96; P = 0.03) in pediatric CD. Maternal smoking during pregnancy was associated with increased risk of hospitalization during the 3-year follow-up period (OR 1.75, CI 95% 1.05–2.89; P = 0.03). Conclusions: Early life environmental factors influence the eventual phenotypes and disease course in CD.
AB - Objectives: Environmental factors play an important role in the pathogenesis of Crohn’s Disease (CD). In particular, by virtue of the instability of the microbiome and development of immunologic tolerance, early life factors may exert the strongest influence on disease risk and phenotype. Methods: We used data from 1119 CD subjects recruited from RISK inception cohort to examine the impact of early life environment on disease progression. Our primary exposures of interest were breastfeeding in infancy and exposure to maternal, active, or passive smoke. Our primary outcomes were development of complicated (stricturing or penetrating) disease, and need for CD-related hospitalization, and surgery. Multivariable logistic regression models were used to define independent associations, adjusting for relevant covariates. Results: Our study cohort included 1119 patients with CD among whom 15% had stricturing (B2) or penetrating disease (B3) by 3 years. 331 patients (35%) and 95 patients (10.6%) required CD-related hospitalizations and surgery respectively. 74.5% were breastfed in infancy and 31% were exposed to smoking among whom 7% were exposed to maternal smoke. On multivariable analysis, a history of breastfeeding was inversely associated with complicated (B2/B3 disease) 0.65, CI 95% 0.44–96; P = 0.03) in pediatric CD. Maternal smoking during pregnancy was associated with increased risk of hospitalization during the 3-year follow-up period (OR 1.75, CI 95% 1.05–2.89; P = 0.03). Conclusions: Early life environmental factors influence the eventual phenotypes and disease course in CD.
UR - https://www.scopus.com/pages/publications/85054397550
U2 - 10.1038/s41395-018-0239-9
DO - 10.1038/s41395-018-0239-9
M3 - Article
C2 - 30267029
AN - SCOPUS:85054397550
SN - 0002-9270
VL - 113
SP - 1524
EP - 1529
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 10
ER -