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Physical Fitness in Adolescence and Subsequent Inflammatory Bowel Disease Risk
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0002-2088-0530
Örebro University, School of Law, Psychology and Social Work, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics.
Örebro University, School of Medicine, Örebro University, Sweden. Department of Gastroenterology.ORCID iD: 0000-0003-0122-7234
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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. Vol. 6, e121
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-47188DOI: 10.1038/ctg.2015.49ISI: 000372104700002PubMedID: 26540026Scopus ID: 2-s2.0-84946544131OAI: oai:DiVA.org:oru-47188DiVA: diva2:888095
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
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: 2017-02-08Bibliographically approved

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