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Stress resilience and the risk of inflammatory bowel disease: a cohort study of men living in Sweden
Örebro University, School of Medical Sciences. Department of Clinical Epidemiology and Biostatistics.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0002-2088-0530
Örebro University, School of Medical Sciences. Department of Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0002-3649-2639
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.ORCID iD: 0000-0003-0122-7234
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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. Vol. 7, no 1, e014315
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:oru:diva-55376DOI: 10.1136/bmjopen-2016-014315ISI: 000395590300171PubMedID: 28130207Scopus ID: 2-s2.0-85010952149OAI: oai:DiVA.org:oru-55376DiVA: diva2:1071840
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: 2017-10-18Bibliographically approved
In thesis
1. Physical and psychological characteristics in adolescence and risk of gastrointestinal disease in adulthood
Open this publication in new window or tab >>Physical and psychological characteristics in adolescence and risk of gastrointestinal disease in adulthood
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
Physical fitness, stress resilience, adolescence, inflammatory bowel disease, peptic ulcer disease, gastrointestinal infections
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-53959 (URN)978-91-7529-176-5 (ISBN)
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: 2017-10-18Bibliographically approved

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