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Physical and psychological characteristics in adolescence and risk of gastrointestinal disease in adulthood
Örebro University, School of Medical Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and objectives: Physical fitness and stress resilience may influence the risk of gastrointestinal (GI) disease. High physical fitness level may reduce levels of systemic inflammation while psychosocial stress exposure can increase inflammation levels and intestinal permeability. The main objectives are to evaluate if poorer physical fitness and stress resilience in adolescence are associated with a raised risk of inflammatory bowel disease (IBD), peptic ulcer disease (PUD) and GI infections in adulthood and to assess evidence of causality.

Materials and methods: Swedish registers provided information on a cohort of approximately 250,000 men who underwent military conscription assessments in late adolescence (1969 –1976) with follow-up until December 2009 (up to age 57 years). Cox regression evaluated the associations of physical fitness and stress resilience in adolescence with subsequent GI disease risk in adulthood.

Results and conclusions: IBD: Poor physical fitness was associated with an increased risk of IBD. The association may be explained (in part) by prodromal disease activity reducing exercise capacity and therefore fitness. Low stress resilience was associated with an increased risk of receiving an IBD diagnosis. Stress may not be an important cause of IBD but may increase the likelihood of conversion from subclinical to symptomatic disease. PUD: Low stress resilience was associated with an increased risk of PUD. This may be explained by a combination of physiological and behavioural mechanisms that increase susceptibility to H. pylori infections and other risk factors. GI infections: Low stress resilience was associated with a reduced risk of GI infections, including enteric infections rather than the hypothesised increased risk.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , 74 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 155
Keyword [en]
Physical fitness, stress resilience, adolescence, inflammatory bowel disease, peptic ulcer disease, gastrointestinal infections
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:oru:diva-53959ISBN: 978-91-7529-176-5 (print)OAI: oai:DiVA.org:oru-53959DiVA: diva2:1056091
Public defence
2017-03-03, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2017-02-08Bibliographically approved
List of papers
1. Physical Fitness in Adolescence and Subsequent Inflammatory Bowel Disease Risk
Open this publication in new window or tab >>Physical Fitness in Adolescence and Subsequent Inflammatory Bowel Disease Risk
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2015 (English)In: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 6, e121Article in journal (Refereed) Published
Abstract [en]

Objectives: Physical fitness may reduce systemic inflammation levels relevant to the risk of symptomatic Crohn's disease (CD) and ulcerative colitis (UC); we assessed if fitness in adolescence is associated with subsequent inflammatory bowel disease (IBD) risk, independent of markers of risk and prodromal disease activity.

Methods: Swedish registers provided information on a cohort of 240,984 men (after exclusions) who underwent military conscription assessments in late adolescence (1969-1976). Follow-up started at least 4 years after the conscription assessment until 31 December 2009 (up to age 57 years). Cox's regression assessed the association of physical fitness with CD (n=986) and UC (n=1,878) in separate models, with adjustment including: socioeconomic conditions in childhood; physical fitness, height, body mass index, and erythrocyte sedimentation rate (ESR) in adolescence; and subsequent diagnoses of IBD.

Results: Low fitness was associated with a raised risk of IBD, with unadjusted hazard ratios (and 95% confidence intervals) of 1.62 (1.31-2.00) for CD and 1.36 (1.17-1.59) for UC. The results were attenuated by adjustment, particularly for markers of prodromal disease activity to 1.32 (1.05-1.66) and 1.25 (1.06-1.48), respectively. Raised ESR in adolescence was associated with increased risks for subsequent CD (5.95 (4.47-7.92)) and UC (1.92 (1.46-2.52)).

Conclusions: The inverse association of physical fitness with IBD risk is consistent with a protective role for exercise. However, evidence of disease activity before diagnosis was already present in adolescence, suggesting that some or all of the association between fitness and IBD may be due to prodromal disease activity reducing exercise capacity and therefore fitness.

Place, publisher, year, edition, pages
New York, USA: Nature Publishing Group, 2015
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-47188 (URN)10.1038/ctg.2015.49 (DOI)000372104700002 ()26540026 (PubMedID)2-s2.0-84946544131 (Scopus ID)
Funder
Swedish Research Council, 521-2011-2764
Note

Funding Agencies:

Stiftelsen Olle Engkvist Byggmästare

UK Economic and Social Research Council (ESRC) RES-596-28-0001  ES/JO19119/1

Örebro University

Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2017-02-06Bibliographically approved
2. Stress resilience and the risk of inflammatory bowel disease: a cohort study of men living in Sweden
Open this publication in new window or tab >>Stress resilience and the risk of inflammatory bowel disease: a cohort study of men living in Sweden
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 1, e014315Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine if low psychosocial stress resilience in adolescence (increasing chronic stress arousal throughout life) is associated with an increased inflammatory bowel disease (IBD) risk in adulthood. Subclinical Crohn's disease (CD) and ulcerative colitis (UC) can exist over many years and we hypothesise that psychosocial stress may result in conversion to symptomatic disease through its proinflammatory or barrier function effects.

DESIGN: National register-based cohort study of men followed from late adolescence to middle age.

SETTING: A general population cohort of men in Sweden.

PARTICIPANTS: Swedish population-based registers provided information on all men born between 1952 and 1956 who underwent mandatory Swedish military conscription assessment (n=239 591). Men with any gastrointestinal diagnoses (except appendicitis) prior to follow-up were excluded.

PRIMARY OUTCOME MEASURES: An inpatient or outpatient diagnosis of CD or UC recorded in the Swedish Patient Register (1970-2009).

RESULTS: A total of 938 men received a diagnosis of CD and 1799 UC. Lower stress resilience in adolescence was associated with increased IBD risk, with unadjusted HRs (95% CIs) of 1.54 (1.26 to 1.88) and 1.24 (1.08 to 1.42), for CD and UC, respectively. After adjustment for potential confounding factors, including markers of subclinical disease activity in adolescence, they are 1.39 (1.13 to 1.71) and 1.19 (1.03 to 1.37).

CONCLUSIONS: Lower stress resilience may increase the risk of diagnosis of IBD in adulthood, possibly through an influence on inflammation or barrier function.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-55376 (URN)10.1136/bmjopen-2016-014315 (DOI)000395590300171 ()28130207 (PubMedID)2-s2.0-85010952149 (Scopus ID)
Note

Funding Agencies:

UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1

Stiftelsen Olle Engkvist Byggmästare

Örebro University

Available from: 2017-02-06 Created: 2017-02-06 Last updated: 2017-03-29Bibliographically approved
3. Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease: a prospective study of 233 093 men in Sweden
Open this publication in new window or tab >>Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease: a prospective study of 233 093 men in Sweden
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2015 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 41, no 10, 1005-1015 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated.

AIM: To assess if stress resilience in adolescence is associated with subsequent PUD risk.

METHODS: The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence.

RESULTS: In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively.

CONCLUSION: Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.

National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-44576 (URN)10.1111/apt.13168 (DOI)000353050600009 ()25809417 (PubMedID)2-s2.0-84927778283 (Scopus ID)
Note

Funding Agencies:

Stiftelsen Olle Engkvist Byggmästare

UK Economic and Social Research Council (ESRC) RES-596-28-0001  ES/JO19119/1

Örebro University

Available from: 2015-05-08 Created: 2015-05-08 Last updated: 2017-02-06Bibliographically approved
4. Resilience to stress and risk of gastrointestinal infections
Open this publication in new window or tab >>Resilience to stress and risk of gastrointestinal infections
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(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-55379 (URN)
Available from: 2017-02-06 Created: 2017-02-06 Last updated: 2017-02-06Bibliographically approved

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