The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children

Livia Lindoso, Kajari Mondal, Suresh Venkateswaran, Hari K. Somineni, Cortney Ballengee, Thomas D. Walters, Anne Griffiths, Joshua D. Noe, Wallace Crandall, Scott Snapper, Shervin Rabizadeh, Joel Rosh, Neal LeLeiko, Stephen Guthery, David Mack, Richard Kellermayer, Ajay S. Gulati, Marian D. Pfefferkorn, Dedrick E. Moulton, David Keljo & 17 others Stanley Cohen, Maria Oliva-Hemker, Melvin B. Heyman, Anthony Otley, Susan S. Baker, Jonathan S. Evans, Barbara S. Kirschner, Ashish S. Patel, David Ziring, Michael C. Stephens, Robert Baldassano, Marla C. Dubinsky, James Markowitz, Lee A. Denson, Jeffrey Hyams, Subra Kugathasan, Ashwin N. Ananthakrishnan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1524-1529
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume113
Issue number10
DOIs
StatePublished - Oct 1 2018

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Environmental Exposure
Crohn Disease
Phenotype
Hospitalization
Breast Feeding
Smoke
Logistic Models
Smoking
Mothers
Maternal Exposure
Microbiota
Disease Progression
Cohort Studies
Pregnancy

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Lindoso, L., Mondal, K., Venkateswaran, S., Somineni, H. K., Ballengee, C., Walters, T. D., ... Ananthakrishnan, A. N. (2018). The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children. American Journal of Gastroenterology, 113(10), 1524-1529. https://doi.org/10.1038/s41395-018-0239-9
Lindoso, Livia ; Mondal, Kajari ; Venkateswaran, Suresh ; Somineni, Hari K. ; Ballengee, Cortney ; Walters, Thomas D. ; Griffiths, Anne ; Noe, Joshua D. ; Crandall, Wallace ; Snapper, Scott ; Rabizadeh, Shervin ; Rosh, Joel ; LeLeiko, Neal ; Guthery, Stephen ; Mack, David ; Kellermayer, Richard ; Gulati, Ajay S. ; Pfefferkorn, Marian D. ; Moulton, Dedrick E. ; Keljo, David ; Cohen, Stanley ; Oliva-Hemker, Maria ; Heyman, Melvin B. ; Otley, Anthony ; Baker, Susan S. ; Evans, Jonathan S. ; Kirschner, Barbara S. ; Patel, Ashish S. ; Ziring, David ; Stephens, Michael C. ; Baldassano, Robert ; Dubinsky, Marla C. ; Markowitz, James ; Denson, Lee A. ; Hyams, Jeffrey ; Kugathasan, Subra ; Ananthakrishnan, Ashwin N. / The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children. In: American Journal of Gastroenterology. 2018 ; Vol. 113, No. 10. pp. 1524-1529.
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abstract = "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.",
author = "Livia Lindoso and Kajari Mondal and Suresh Venkateswaran and Somineni, {Hari K.} and Cortney Ballengee and Walters, {Thomas D.} and Anne Griffiths and Noe, {Joshua D.} and Wallace Crandall and Scott Snapper and Shervin Rabizadeh and Joel Rosh and Neal LeLeiko and Stephen Guthery and David Mack and Richard Kellermayer and Gulati, {Ajay S.} and Pfefferkorn, {Marian D.} and Moulton, {Dedrick E.} and David Keljo and Stanley Cohen and Maria Oliva-Hemker and Heyman, {Melvin B.} and Anthony Otley and Baker, {Susan S.} and Evans, {Jonathan S.} and Kirschner, {Barbara S.} and Patel, {Ashish S.} and David Ziring and Stephens, {Michael C.} and Robert Baldassano and Dubinsky, {Marla C.} and James Markowitz and Denson, {Lee A.} and Jeffrey Hyams and Subra Kugathasan and Ananthakrishnan, {Ashwin N.}",
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Lindoso, L, Mondal, K, Venkateswaran, S, Somineni, HK, Ballengee, C, Walters, TD, Griffiths, A, Noe, JD, Crandall, W, Snapper, S, Rabizadeh, S, Rosh, J, LeLeiko, N, Guthery, S, Mack, D, Kellermayer, R, Gulati, AS, Pfefferkorn, MD, Moulton, DE, Keljo, D, Cohen, S, Oliva-Hemker, M, Heyman, MB, Otley, A, Baker, SS, Evans, JS, Kirschner, BS, Patel, AS, Ziring, D, Stephens, MC, Baldassano, R, Dubinsky, MC, Markowitz, J, Denson, LA, Hyams, J, Kugathasan, S & Ananthakrishnan, AN 2018, 'The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children', American Journal of Gastroenterology, vol. 113, no. 10, pp. 1524-1529. https://doi.org/10.1038/s41395-018-0239-9

The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children. / Lindoso, Livia; Mondal, Kajari; Venkateswaran, Suresh; Somineni, Hari K.; Ballengee, Cortney; Walters, Thomas D.; Griffiths, Anne; Noe, Joshua D.; Crandall, Wallace; Snapper, Scott; Rabizadeh, Shervin; Rosh, Joel; LeLeiko, Neal; Guthery, Stephen; Mack, David; Kellermayer, Richard; Gulati, Ajay S.; Pfefferkorn, Marian D.; Moulton, Dedrick E.; Keljo, David; Cohen, Stanley; Oliva-Hemker, Maria; Heyman, Melvin B.; Otley, Anthony; Baker, Susan S.; Evans, Jonathan S.; Kirschner, Barbara S.; Patel, Ashish S.; Ziring, David; Stephens, Michael C.; Baldassano, Robert; Dubinsky, Marla C.; Markowitz, James; Denson, Lee A.; Hyams, Jeffrey; Kugathasan, Subra; Ananthakrishnan, Ashwin N.

In: American Journal of Gastroenterology, Vol. 113, No. 10, 01.10.2018, p. 1524-1529.

Research output: Contribution to journalArticle

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

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.

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.

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U2 - 10.1038/s41395-018-0239-9

DO - 10.1038/s41395-018-0239-9

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SP - 1524

EP - 1529

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 10

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