Environmental risk factors in inflammatory bowel disease: A population-based case-control study in Asia-Pacific

Siew C. Ng, Whitney Tang, Rupert W. Leong, Minhu Chen, Yanna Ko, Corrie Studd, Ola Niewiadomski, Sally Bell, Michael A. Kamm, H. J. De Silva, Anuradhani Kasturiratne, Yasith Udara Senanayake, Choon Jin Ooi, Khoon Lin Ling, David Ong, Khean Lee Goh, Ida Hilmi, Qin Ouyang, Yu Fang Wang, Pin Jin HuZhenhua Zhu, Zhirong Zeng, Kaichun Wu, Xin Wang, Bing Xia, Jin Li, Pises Pisespongsa, Sathaporn Manatsathit, Satimai Aniwan, Marcellus Simadibrata, Murdani Abdullah, Steve W.C. Tsang, Tai Chiu Wong, Aric J. Hui, Chung Mo Chow, Hon Ho Yu, Mo Fong Li, Ka Kei Ng, Jessica Ching, Justin C.Y. Wu, Francis K.L. Chan, Joseph J.Y. Sung

Research output: Contribution to journalArticlepeer-review

186 Citations (Scopus)


Objective The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. Design 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. Results: In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. Conclusions: This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life.

Original languageEnglish
Pages (from-to)1063-1071
Number of pages9
Issue number7
Publication statusPublished - 1 Jul 2015

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