Anne Sütü ile Beslenmenin İnflamatuar Bağırsak Hastalığı Gelişme Riski Üzerine Etkisi

Abstract

Amaç: Bu çalışmanın amacı, erken çocukluk döneminde anne sütü almanın inflamatuar bağırsak hastalığı (İBH) gelişme riskini etkileyip etkilemediğini araştırmaktır. Gereç ve Yöntem: Anketten elde edilen hasta verileri İBH olmayan kardeşlerinden oluşan kontrol grubu ile karşılaştırıldı. Annesütü alma durumu ile İBH hastalarının demografik ve klinik özellikleri arasındaki ilişki de ayrıca analiz edildi. Bulgular: Çalışmaya 304 İBH hastası dahil edildi. Hastaların 182'si (%59,9) ülsaratif kolit (ÜK), 122'si (%40,1) Crohn hastalığı (CH) tanılıydı. Çalışmaya dahil edilen Crohn hastalarının verileri 332 kişilik CH kardeş grubu ile ve ÜK hastalarının verileri de 508 kişilik ÜK kardeş grubunun verileri ile karşılaştırıldı. Hiç anne sütü almayanların oranı hem CH hem de ÜK grubunda, kontrol grubuna göre anlamlı olarak daha yüksekti (CH için %7,4 ve %2,1 [p=0,017] ve ÜK için %3,9 ve %0,8 [p=0,010]) ve hiç anne sütü almayanlarda hastalık riski anlamlı olarak artmıştı (CH için OR= 3,70 [1,35-10,16] [p=0,017] ve ÜK için OR= 5,07 [1,47-17,53] [p=0,010]). Ayrıca anne sütü alma süresi arttıkça CH'a karşı koruyucu etkinin arttığı, ÜK için ise 12 aya kadar emzirme ile koruyucu etkinin arttığı, ancak12 aydan fazla anne sütü almanın ek koruma sağlamadığı belirlendi. Anne sütü alma ile hastaların demografik ve klinik özellikleri arasında ilişki saptanmadı. Sonuç: Bebeklik döneminde anne sütü almamış olanlarda hem ÜK hem de CH gelişme riski artmakta ve emzirme süresi arttıkça hastalık riskinden koruyuculuk artmaktadır.

Keywords

• Crohn hastalığı
• Ülseratif kolit
• anne sütü
• hastalık riski

Effect of Breastfeeding on the Risk of Developing Inflammatory Bowel Disease

Abstract

Aim: This study aimed to investigate whether breastfeeding in early childhood affect the risk of devoloping inflammatory bowel disease (IBD). Materials and Methods: The data of patients obtained from the survey were compared to the data of their non-IBD siblings as a control group. The relationship between the demographic and clinical chararecteristics of IBD patients and breastfeeding was also analyzed. Results: 304 IBD patients were included in the study. 182 (59.9%) of the patients were diagnosed with ulcerative colitis (UC), and 122 (40.1%) with Crohn’s disease (CD). The CD patients included in the study were compared to the CD siblings group of 332, and the UC patients compared with the UC siblings group of 508. Compared to the control groups, the proportion of those who never breastfed was higher in both the CD and UC groups (7.4% vs. 2.1% for CD [p=0.017] and 3.9% vs. 0.8% for UC [p=0.01]), and the risk of disease increased in those who was not breastfed (OR= 3.70 [1.35-10.16] for CD [p=0.017] and OR= 5.07 for UC [1.47-17.53] [p=0.010]). The protective effect against CD increased as the duration of breastfeeding increased, but that the protection increased with breastfeeding for up to 12 months for UC, and breastfeeding for more than 12 months did not provide additional protection. There was no relationship between breastfeeding and demographic and behavioral chracteristics of patients Conclusions: Not having been breastfed in infancy increases the risk of developing both UC and CD, and as the duration of breastfeeding increases, the protection against diseases risk increases.

Keywords

• Crohn's disease
• ulcerative colitis
• breastfeeding
• disease risk

References

1. 1. Chu H, Khosravi A, Kusumawardhani IP, et al. Gene-microbiota interactions contribute to the pathogenesis of inflammatory bowel disease. Science. 2016; 352:1116–1120.
2. 2. Gordon H, Trier Moller F, Andersen V, Harbord M. Heritability in inflammatory bowel disease: from the first twin study to genome-wide association studies. Inflamm Bowel Dis. 2015; 21:1428-1434.
3. 3. Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses. Gastroenterology. 2019; 157: 647-659.
4. 4. Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014; 146:1489–1499.
5. 5. Sartor RB, Wu GD. Roles for Intestinal Bacteria, Viruses, and Fungi in Pathogenesis of Inflammatory Bowel Diseases and Therapeutic Approaches. Gastroenterology. 2017; 152: 327-339.
6. 6. Brahm P, Valdés V. Beneficios de la lactancia materna y riesgos de no amamantar [The benefits of breastfeeding and associated risks of replacement with baby formulas]. Rev Chil Pediatr. 2017; 88: 7-14.
7. 7. Vieira Borba V, Sharif K, Shoenfeld Y. Breastfeeding and autoimmunity: Programing health from the beginning. Am J Reprod Immunol. 2017; e12778.
8. 8. Kim YJ. Immunomodulatory Effects of Human Colostrum and Milk. Pediatr Gastroenterol Hepatol Nutr. 2021; 24: 337-345.

9. 9. Sağlam NÖ, Bülbül L, Kazancı SY, Hatipoğlu SS. Factors Affecting Breastfeeding and Complementary Feeding Choices for Children Aged 24 to 48 Months. Sisli Etfal Hastan Tip Bul. 2019 53:165-171.
10. 10. Ward RE, Niñonuevo M, Mills DA, Lebrilla CB, German JB. In vitro fermentation of breast milk oligosaccharides by Bifidobacterium infantis and Lactobacillus gasseri. Appl. Environ. Microbiol. 2006; 72: 4497–4499.
11. 11. Ackerman DL, Craft KM, Doster RS, et al. Antimicrobial and antibiofilm activity of human milk oligosaccharides against Streptococcus agalactiae, Staphylococcus aureus, and Acinetobacter baumannii. ACS Infect. Dis. 2017; 4: 315–324.
12. 12. Van der Sloot KWJ, Amini M, Peters V, Dijkstra G, Alizadeh BZ. Inflammatory Bowel Diseases: Review of Known Environmental Protective and Risk Factors Involved. Inflamm Bowel Dis. 2017; 23: 1499-1509.
13. 13. Xu L, Lochhead P, Ko Y, Claggett B, Leong RW, Ananthakrishnan AN. Systematic review with meta-analysis: breastfeeding and the risk of Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2017; 46: 780-789.
14. 14. Khalili H, Ananthakrishnan AN, Higuchi LM, Richter JM, Fuchs CS, Chan AT. Early life factors and risk of inflammatory bowel disease in adulthood. Inflamm Bowel Dis. 2013; 19: 542-547.
15. 15. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005; 19; 5A-36A.
16. 16. Ng SC, Tang W, Leong RW, et al. Asia-Pacific Crohn's and Colitis Epidemiology Study ACCESS Group. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut. 2015; 64: 1063-1071.
17. 17. Klement E, Cohen RV, Boxman J, Joseph A, Reif S. Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis. Am J Clin Nutr. 2004; 80: 1342-1352.
18. 18. Sonntag B, Stolze B, Heinecke A, et al. Preterm birth but not mode of delivery is associated with an increased risk of developing inflammatory bowel disease later in life. Inflamm Bowel Dis. 2007; 13: 1385-1390.
19. 19. Niewiadomski O, Studd C, Wilson J, et al. Influence of food and lifestyle on the risk of developing inflammatory bowel disease. Intern Med J. 2016 ; 46: 669-676.
20. 20. Wang YF, Ou-Yang Q, Xia B, et al. Multicenter case-control study of the risk factors for ulcerative colitis in China. World J Gastroenterol. 2013; 19: 1827-1833.
21. 21. Castiglione F, Diaferia M, Morace F, et al. Risk factors for inflammatory bowel diseases according to the "hygiene hypothesis": a case-control, multi-centre, prospective study in Southern Italy. J Crohns Colitis. 2012; 6: 324-329.
22. 22. Baron S, Turck D, Leplat C, et al. Environmental risk factors in paediatric inflammatory bowel diseases: a population based case control study. Gut. 2005; 54: 357-363.
23. 23. Palmeira P, Carneiro-Sampaio M. Immunology of breast milk. Rev Assoc Med Bras 2016 ; 62: 584-593. 24. Gephart SM, Weller M. Colostrum as oral immune therapy to promote neonatal health. Adv Neonatal Care. 2014; 14: 44-51.
24. 25. Ciardelli L, Garofoli F, Stronati M, et al. Human colostrum T lymphocytes and their effector cytokines actively aid the development of the newborn immune system. Int J Immunopathol Pharmacol. 2008; 21: 781-786.
25. 26. Ko Y, Kariyawasam V, Karnib M, et al. IBD Sydney Organisation. Inflammatory Bowel Disease Environmental Risk Factors: A Population-Based Case-Control Study of Middle Eastern Migration to Australia. Clin Gastroenterol Hepatol. 2015; 13: 1453-1463.
26. 27. Hlavaty T, Toth J, Koller T, et al. Smoking, breastfeeding, physical inactivity, contact with animals, and size of the family influence the risk of inflammatory bowel disease: A Slovak case-control study. United European Gastroenterol J. 2013; 1: 109-119.
27. 28. Hansen TS, Jess T, Vind I, et al. Environmental factors in inflammatory bowel disease: a case-control study based on a Danish inception cohort. J Crohns Colitis. 2011; 5: 577-584.
28. 29. Gökden Y , Ogutmen Koc D. Evaluation of potential early life risk factors for ulcerative colitis. J Surg Med. 2020; 4: 1013-1017.
29. 30. Gearry RB, Richardson AK, Frampton CM, Dodgshun AJ, Barclay ML. Population-based cases control study of inflammatory bowel disease risk factors. J Gastroenterol Hepatol. 2010; 25: 325-333.
30. 31. Strisciuglio C, Giugliano F, Martinelli M, et al. Impact of Environmental and Familial Factors in a Cohort of Pediatric Patients With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2017; 64: 569-574.