Abstract
Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter. We and others have hypothesized that elevated f-Hb (measured using a faecal immunochemical test) has considerable potential to identify individuals at risk of, or who already have, early stage, undiagnosed chronic disease. If f-Hb does prove to be an effective biomarker for chronic disease and multimorbidity, individuals with detectable f-Hb, but without an obvious source of gastrointestinal blood loss, could benefit from further assessment and early intervention. To test this hypothesis rigorously, longitudinal data-linkage methodology is required linking colorectal cancer screening data, and data on patients presenting with lower gastrointestinal symptoms, with routinely collected health information.
Highlights
Non-communicable disease is the major cause of morbidity and premature death in developed countries, and chronic conditions frequently co-exist [1]
A study performed in Scotland demonstrated that an abnormal guaiac faecal occult blood test result, which can be considered as a marker for elevated faecal haemoglobin concentration (f-Hb), was shown to be associated with an increased risk of death, from colorectal cancer (CRC), and from all-causes, cardiovascular disease, respiratory disease, digestive disease, neuropsychological conditions, and endocrine disease [20]
It was thought that these results provided additional and substantial weight to the concept that detectable f-Hb is associated with a range of common chronic conditions that have a component of systemic inflammation
Summary
Non-communicable disease is the major cause of morbidity and premature death in developed countries, and chronic conditions frequently co-exist [1]. A study performed in Scotland demonstrated that an abnormal (positive) guaiac faecal occult blood test (gFOBT) result, which can be considered as a marker for elevated f-Hb, was shown to be associated with an increased risk of death, from CRC, and from all-causes, cardiovascular disease, respiratory disease, digestive disease, neuropsychological conditions, and endocrine disease [20]. It was considered that f-Hb might have potential in identifying those individuals who are at high risk of developing chronic conditions or who are at an early stage of disease In another recent South Korean study involving screening participants, positive FIT results were associated with psoriasis, a chronic inflammatory skin disease, suggesting to the authors a relationship between skin disorders and gut health [27]. PM2.5 enhanced the risk of being in a preclinical state by 14% (95% CI: 10–18) and that of subsequent progression from a pre-clinical to a clinical state by 21% (95% CI: 14–28)
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