Children with Crohn’s disease who are breastfed are less likely to experience progression to stricturing or penetrating disease, while other environmental factors, like smoking, are linked to adverse events among this population, according to research published in The American Journal of Gastroenterology.
Ashwin N. Ananthakrishnan, MD, MPH, of the division of gastroenterology at Massachusetts General Hospital, and colleagues examined how life and environmental factors can impact disease phenotype in CD during the “sensitive” time of infancy and early childhood.
“The key pathogenic mechanism behind CD is a dysregulated immune response to commensal intestinal flora in a genetically susceptible host,” they wrote. “Both the gut microbiome and the development of immunologic tolerance are more susceptible to external influences early in infancy and childhood. Thus, early life environmental influences may offer the greatest potential to alter susceptibility to CD risk and behavior.”
Researchers analyzed data from 1,119 patients with CD (mean age, 12; 38.8% female) from the RISK inception cohort for the study. In their exploration of life factors, they focused on breastfeeding in infancy and exposure to maternal, active, or passive smoking.
Among the study cohort, 15% of patients had stricturing disease or penetrating disease by age 3, while 35% required CD-related hospitalization and 10.6% required CD-related surgery. A total of 785 patients were breastfed (74.5%), and 347 were exposed to some kind of smoking (31%), including 75 (31%) who were exposed to maternal smoking.
In a multivariable analysis, investigators found that history of breastfeeding was inversely associated with complicated disease (stricturing or penetrating; OR = 0.65; 95% CI, 0.44–96). They also found that maternal smoking during pregnancy was associated with an increased risk for hospitalization during the 3-year follow-up period (OR = 1.75; 95% CI, 1.05–2.89).
Ananthakrishnan and colleagues wrote that exploring these findings could help investigators better understand how environmental factors affect CD progression. However, they wrote that future studies with larger cohorts are needed.
“These findings may suggest that epigenetic imprinting or microbial alterations secondary to such exposures even during pregnancy or early infancy may exert a durable disease-modifying influence and offer key insights into disease pathogenesis,” they wrote. – by Alex Young
Disclosures: The authors report no relevant financial disclosures.