Abstract

Body mass index (BMI) is associated with increased future risk of inflammatory bowel disease(IBD) particularly Crohn’s disease(CD), where associations with high and low BMI have been observed. Most studies are based on adult women. We aimed to explore the impact of BMI in men entering adult life on their long-term risk of developing IBD. A total of 377,957 men born during 1939–1959, with BMI measured at draft boards at mean age 19, were followed from 1977, or time of examination, to end of 2015. Risk of IBD was assessed using Cox regression. During 13 million person-years of follow-up, 1,523 developed CD and 3,323 UC. Using normal weight as reference, for CD the following HRs were observed: BMI < 18.5, 1.35; 95% CI, 1.12–1.62, BMI 25–29.9; 0.83; 95% CI, 0.68–1.02. and BMI > 30 1.20; 95% CI, 0.75–1.90). The increased risk of CD in underweight was maintained up until age 60 not explained by known effects of smoking. For UC, minor inverse associations were observed. Restricted cubic splines revealed a U-shape association between BMI and CD, but not UC. Low BMI of men entering adult life is associated with an increased incidence of CD and UC up to 40 years later.

Highlights

  • Inflammatory bowel diseases are somehow diseases of modernity, there is uncertainty as to what aspects of modernity are responsible

  • In a limited number of studies, elevated body mass index associates with future risk of Crohn’s disease(CD) but not ulcerative colitis(UC)[7,8,9], to date studies have largely been in adult women and children[8]

  • During around 13 million person-years of follow up, 1,523 men were diagnosed with CD at a mean (SD) age of 47.0 (13.0) years, and 3,323 men were diagnosed with UC at a mean (SD) age of 49.7 (12.0) years

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Summary

Introduction

Inflammatory bowel diseases are somehow diseases of modernity, there is uncertainty as to what aspects of modernity are responsible. It is widely appreciated that at the time of diagnosis in younger subjects with Crohn’s disease that body mass index is reduced[4,5,6]. In a limited number of studies, elevated body mass index associates with future risk of Crohn’s disease(CD) but not ulcerative colitis(UC)[7,8,9], to date studies have largely been in adult women and children[8]. In one prospective study in adult women[10] and a case-control study in both sexes[9], low BMI, was associated with risk. The lack of association of low BMI with risk of CD in a large study of children[8] raises the possibilities that either changes in physiology and immune function, sub-clinical disease onset, or changes in risk factor profile, www.nature.com/scientificreports/. Notably initiation of smoking, occurring at the time of puberty, could possibly explain the association with adult risk

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