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Impact of Environmental and Familial Factors in a Cohort of Pediatric Patients With Inflammatory Bowel Disease

Strisciuglio, Caterina*,†; Giugliano, Francesca*; Martinelli, Massimo*; Cenni, Sabrina*; Greco, Luigi*; Staiano, Annamaria*; Miele, Erasmo*

Journal of Pediatric Gastroenterology and Nutrition: April 2017 - Volume 64 - Issue 4 - p 569–574
doi: 10.1097/MPG.0000000000001297
Original Articles: Gastroenterology: Inflammatory Bowel Disease

Objectives: The primary role of environment on inflammatory bowel disease (IBD) onset has been recently stressed. We aimed to investigate the effect of environmental factors in an IBD pediatric cohort.

Methods: A total of 467 subjects (264 IBD and 203 controls) were enrolled. All patients underwent a questionnaire including 5 different groups of environmental risk factors: family history of IBD and autoimmune diseases, perinatal period, home amenities and domestic hygiene, childhood diseases and vaccinations, and diet.

Results: In a multivariate model, mother's degree (odds ratio [OR]: 5.5; 2.5–11.6), duration of breast feeding >3rd month (OR: 4.3; 1.6–10.5), father's employment (OR: 3.7; 1.2–8.7), gluten introduction <6th month (OR: 2.8; 1.5–5), number of siblings <2 (OR: 2.8; 1.5–5.3), and family history of autoimmune diseases (OR: 2.7; 1.4–5.3) were significant risk factors for Crohn disease. Low adherence to Mediterranean diet (OR: 2.3; 1.2–4.5), gluten introduction <6th month (OR: 2.8; 1.6–4.9), and number of siblings <2 (OR: 2; 1.1–3.6) were significant risk factors for ulcerative colitis. Owning pets (OR: 0.3; 0.1–0.7) and bed sharing (OR: 0.2; 0.1–0.6) were protective factors for Crohn disease, whereas owning pets (OR: 0.4; 0.2–0.8) and family parasitosis (OR: 0.07; 0.01–0.4) were protective factors for ulcerative colitis.

Conclusions: Our study confirms that environmental factors are closely linked to IBD onset and may partly explain IBD rise in developed countries.

Supplemental Digital Content is available in the text

*Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Naples

Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.

Address correspondence and reprint requests to Erasmo Miele, MD, Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via S. Pansini, n. 5, 80131, Naples, Italy (e-mail:

Received 1 February, 2016

Accepted 3 June, 2016

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Dr Strisciuglio, Giugliano, and Dr Martinelli contributed equally to the article.

A.S. served as investigator and member of advisory board for the following companies: D.M.G, Valeas, Angelini, Miltè, Danone, Nestlé, Sucampo, and Menarini. The other authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,