Environmental Risk Factors for Childhood Inflammatory Bowel Diseases: A Multicenter Case-Control Study

Mohammed Hasosah; Wafaa Alhashmi; Renad Abualsaud; Anas Alamoudi; Afnan Aljawad; Mariam Tunkar; Nooran Felemban; Ahmed Basalim; Muhammad Khan; Aziz Alanazi; Ali Almehaidib

doi:10.3390/children9030438

Environmental Risk Factors for Childhood Inflammatory Bowel Diseases: A Multicenter Case-Control Study

Children (Basel). 2022 Mar 21;9(3):438. doi: 10.3390/children9030438.

Authors

Affiliations

¹ Pediatric Gastroenterology Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah 11481, Saudi Arabia.
² College of Medicine, King Abdulaziz University, Jeddah 11481, Saudi Arabia.
³ College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia.
⁴ Department of Pediatric Gastroenterology, King Faisal Specialist Hospital & Research Center, Riyad 11211, Saudi Arabia.

Abstract

Objective: Multiple environmental factors can be linked to the development of inflammatory bowel disease (IBD).With an increase in the cases of IBD, the objective of this research is to investigate environmental risk factors for IBD in the Saudi population. Methods: A retrospective multicenter case−control study was performed among IBD children from 2009 to 2021.The variables analyzed to be the possible risk factors included their socioeconomic status, living and demographic characteristics, and lifestyle related to IBD. The questionnaire included a list of IBD risk factors that was given to the control and the patient group. For every variable, the 95% confidence interval (CI) and odds rations were also estimated. Results: There were 335 individuals considered in this study: 168 controls (50.1%) and 167 IBD patients (49.9%). Of these, 93 IBD patients (56%) had CD and 74 patients (44%) had UC. Most of participants were female (72.1%) and were aged above 10 years (51.5%). Vaginal delivery (OR 0.551, 95% CI: 1.59−4.14), age above 10 years (OR 1.040, 95% CI: 1.012−1.069), deficient fruit intake (OR 2.572, 95% CI: 1.59−4.14), no exposure to antibiotics (OR 2.396, 95% CI: 1.51−3.81), appendectomy (OR 2.098, 95% CI: 1.87−2.35), less physical activity (OR 2.033, 95% CI: 1.05−3.93) and gastroenteritis admissions > 2 times/year (OR 0.107, 95% CI: 0.037−0.311) were the risk factors for IBD. These factors depicted a more significant link with CD than UC (p < 0.05). Interestingly, sleep disturbance was estimated to be a CD risk factor (adjusted OR: 3.291, 95% CI = 0.97−11.22). Pets in house was risk factor for UC (p < 0.001). Conclusions: This study highlights association between vaginal delivery, age above 10 years, deficient fruit intake, low physical activity, exposure to antibiotics, appendectomy, and frequent gastroenteritis admissions as risk factors for IBD. Knowledge of these risk factors can help pediatricians to prospectively identify patients at risk of environmental exposure.

Keywords: Crohn’s disease; environmental risk factors; inflammatory bowel diseases; ulcerative colitis.