What puts kids at risk for pediatric inflammatory bowel disease (IBD) and what could help prevent it?
A review of 36 observational studies that included 6.4 million kids offers some key clues.
Taking antibiotics at an early age, eating a Western diet and living in a more affluent family were associated with an increased IBD risk. But living in a household with pets and siblings and eating plenty of veggies were linked to a lower risk.
“Pediatric IBD cases are rising globally, and approximately 1 in 4 of all IBD cases are now diagnosed before age 21,” said lead author Nisha Thacker, a gastrointestinal dietitian who did the meta-analysis as part of her doctoral studies at the University of Newcastle in Australia.
IBD is marked by abdominal pain, diarrhea and blood in the stools, indicating that parts of the intestinal tract have become inflamed.
The new analysis, presented Sunday at a conference of the American Gastroenterological Association, found that kids who took antibiotics before age 5 had triple the risk for pediatric IBD. Their risk was 3.5 times higher if they had received four or more courses of antibiotics by that age.
Exposure to secondhand smoke doubled IBD risk.
Surprisingly, lower economic status appeared to have a protective effect: It was associated with a 65% lower risk of IBD.
Exposure to animals and having only one toilet in the home were also linked to a protective effect.
Why? Thacker pointed to hygiene.
Excessive hygiene can reduce the number of microbes in the environment, which may impede development of a robust microbiome in the child, she said. The microbiome is the community of bacteria that live in the digestive tract and on the body.
While basic hygiene is recommended, Thacker said it’s important to let kids play outside and interact with pets to help develop a strong immune system. In other words, there’s such a thing as too clean.
“Many of these factors can impact our gut microbiota and may have a particularly strong effect in a child,” she said in a meeting news release. “A Western diet, high in sugars and ultra-processed foods and low in vegetables, is a prime example.”
Families with young children should eat a diet rich in vegetables and minimally processed whole foods, Thacker said. She also urged families to consider adopting a pet and take steps to prevent secondhand smoke, avoid excessive hygiene and use antibiotics cautiously.
Breastfeeding and then feeding a child a healthy diet may minimize the effects of a Western diet on someone with a family history of IBD or a personal history of eczema/rhinitis, according to the study.
Thacker also found that being a child of color living in a high-income country tripled the risk of pediatric IBD. She next plans to study the influence of migration on the disease.
Pediatric IBD may have an impact on a child’s growth and the progression of puberty because of the inflammation involved.
The conference was held in Chicago and online. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.
Boston Children’s Hospital has more on inflammatory bowel disease.
SOURCE: American Gastroenterological Association, news release, May 7, 2023
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