Children and adolescents face greater risk of inflammatory bowel disease (IBD) when exposed to antibiotics or a Western diet at early ages, or when their family has higher socioeconomic status, according to a study being presented at the Digestive Disease Week® (DDW) 2023 conference in Chicago, USA.

Children and adolescents face greater risk of inflammatory bowel disease (IBD) when exposed to antibiotics or a Western diet at early ages, or when their family has higher socioeconomic status, according to a study being presented at the Digestive Disease Week® (DDW) 2023 conference in Chicago, USA.

“Paediatric IBD cases are rising globally, and approximately 1 in 4 of all IBD cases are now diagnosed before age 21,”

said Nisha Thacker, the study’s lead author and a gastrointestinal dietitian. A unique concern about pediatric IBD is the impact that the inflammation has on a child’s growth and the progression of puberty, so parents should be aware of this condition and the modifiable factors that influence it.

As a part of her PhD studies through The University of Newcastle and The Children’s Hospital Westmead (Sydney Children’s Hospitals Network) in Australia, she conducted a meta-analysis of 36 observational studies representing approximately 6.4 million children. Thacker found that any exposure to antibiotics before age 5 was linked to a 3 times greater risk of paediatric IBD, and exposure to four or more courses of antibiotics to a 3.5 times greater risk.

Lower socioeconomic status appears to be a protective factor that is associated with a 65% lower risk of childhood IBD. Greater consumption of vegetables was also protective, as was having two or more siblings, and being exposed to pets during childhood years.
The findings that exposure to animals and having only one toilet are protective of IBD indicate that excessive hygiene can reduce microbes in the environment and interfere with development of a robust microbiome, Thacker said. Practicing basic hygiene is still recommended, however, allowing children to play outdoors, interact with pets in a safe and supervised environment and relaxing the behaviour around constant high levels of hygiene appear to be beneficial in terms of developing stronger immune system.

Another risk factor is early exposure to secondhand smoke, which doubled the risk of IBD in children. “Many of these factors can negatively impact our gut microbiota and may have a particularly strong effect in a child,” Thacker said. “A Western diet, high in sugars and ultra-processed foods and low in vegetables, is a prime example.”
A novel risk factor identified was being a non-Caucasian child living in a high-income country increased the risk 3 folds. This influence of migration is the next focus of Ms. Thacker’s research.

Thacker advised families with young children to emphasize a diet rich in vegetables and minimally processed whole foods, use antibiotics cautiously in early childhood, consider adopting a pet, prevent secondhand smoke exposure and avoid excessive worry about hygiene, especially in high-income countries. If a family history of IBD or a child’s history of eczema/rhinitis exists, encouraging and supporting breastfeeding, followed by a healthy diet pattern for children may minimize compounding effects of a Western diet pattern on the genetic risk. Furthermore, if the child is from a non-Caucasian ethnic background living in a high-income country, supporting breastfeeding, promoting healthy minimally processed weaning foods and healthy diet pattern thereafter may help in minimising the risk of developing IBD in children of immigrant families.
 

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 6 – 9 in Chicago and virtually. The meeting showcases more than 3,500 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.