Tine Jess

Antibiotic exposure in early life and childhood overweight and obesity: A systematic review and meta‐analysis

We conducted a systematic review and meta‐analysis of observational studies investigating the association between antibiotic exposure in infancy and risk of childhood overweight and obesity. Thirteen studies, including a total of 527u2009504 children, were included in the systematic review and 8 were included in meta‐analyses. Exposure to antibiotics in infancy was associated with an increased odds ratio (OR) of childhood overweight and obesity (OR 1.11, 95% confidence interval [CI] 1.02‐1.20). Whereas exposure to 1 treatment only and exposure between 6 and 24u2009months were not associated with increased risk of childhood overweight and obesity, exposure to >1 treatment was associated with an OR of 1.24 (95% CI 1.09‐1.43) and exposure within the first 6 months of life was associated with an OR of 1.20 (95% CI 1.04‐1.37). In conclusion, antibiotic exposure in infancy was associated with a slightly increased risk of childhood overweight and obesity, mainly if children were exposed to repeated treatments or treatment within the first 6 months of life. It is unclear whether this association is mediated via direct effects of antibiotics on the gut microbiota.

Inflammatory bowel disease increases the risk of Parkinson’s disease: a Danish nationwide cohort study 1977–2014

Objective Intestinal inflammation has been suggested to play a role in development of Parkinson’s disease (PD) and multiple system atrophy (MSA). To test the hypothesis that IBD is associated with risk of PD and MSA, we performed a nationwide population-based cohort study. Design The cohort consisted of all individuals diagnosed with IBD in Denmark during 1977–2014 (n=76 477) and non-IBD individuals from the general population, who were comparable in terms of gender, age and vital status (n=7 548 259). All cohort members were followed from IBD diagnosis/index date to occurrence of PD and MSA (according to the Danish National Patient Register). Results Patients with IBD had a 22% increased risk of PD as compared with non-IBD individuals (HR=1.22; 95% CI 1.09 to 1.35). The increased risk was present independently of age at IBD diagnosis, gender or length of follow-up. The overall incidence of MSA was low in our study, and the regression analysis suggested a tendency towards higher risk of developing MSA in patients with IBD as compared with non-IBD individuals (HR=1.41; 95% CI 0.82 to 2.44). Estimates were similar for women and men. The increased risk of parkinsonism was significantly higher among patients with UC (HR=1.35; 95% CI 1.20 to 1.52) and not significantly different among patients with Crohn’s disease (HR=1.12; 95% CI 0.89 to 1.40). Conclusions This nationwide, unselected, cohort study shows a significant association between IBD and later occurrence of PD, which is consistent with recent basic scientific findings of a potential role of GI inflammation in development of parkinsonian disorders.

Comparison of Infliximab and Adalimumab in Biologic-Naive Patients With Ulcerative Colitis: A Nationwide Danish Cohort Study

Background & Aims This study compares the effectiveness and safety of infliximab and adalimumab in biologic‐naive patients with ulcerative colitis (UC), in a nationwide register‐based propensity score–matched cohort study. Methods From 1719 adults with UC, between ages 15 and 75 years in Denmark treated with either infliximab or adalimumab as their first biologic agent, we compared rates of all‐cause hospitalization, UC‐related hospitalization, major abdominal surgery, and serious infections after a variable 2:1 propensity score matching, accounting for baseline clinical characteristics, disease severity, health care utilization, and use of UC‐related medications. Results As compared with infliximab‐treated patients, adalimumab‐treated patients had higher rate of all‐cause hospitalization (hazard ratio [HR], 1.84; 95% CI, 1.18–2.85) and a trend toward higher rate of UC‐related hospitalization (HR, 1.71; 95% CI, 0.95–3.07), particularly in a stratum of patients on concomitant immunomodulator therapy. However, risk of abdominal surgery (HR, 1.35; 95% CI, 0.62–2.94) was not different between the 2 treatment groups. Risk of serious infection requiring hospitalization was significantly higher in adalimumab‐treated patients (HR, 5.11; 95% CI, 1.20–21.80). Conclusions In this nationwide propensity score matched–cohort study of biologic‐naive adults with UC, use of adalimumab as first‐line biologic over infliximab was associated with higher risk of hospitalization and serious infections, although risk of surgery was not different. In the absence of head‐to‐head trials, this evidence may assist patients, health care providers, purchasers, and policy makers to make informed decisions that may improve health care in UC.

Comparison of infliximab with adalimumab in 827 biologic-naïve patients with Crohn's disease: a population-based Danish cohort study

There are conflicting data on comparative effectiveness of adalimumab and infliximab in patients with Crohns disease (CD).

Cardiovascular risk profile among patients with inflammatory bowel disease: a population-based study of >100,000 individuals

BACKGROUND AND AIMSnPatients with inflammatory bowel disease have increased risks of cardiovascular diseases, but the role of traditional and non-traditional cardiovascular risk factors remains unclear. We investigated if the cardiovascular risk profile differs between patients with inflammatory bowel disease and individuals in the general population.nnnMETHODSnWe included a population of 108789 participants from the Copenhagen General Population Study of individuals of Danish descent aged 20-100 years. The population included 1203 individuals with prevalent inflammatory bowel disease [347 with Crohns disease and 856 with ulcerative colitis]. The cardiovascular risk profile was assessed by traditional risk factors [plasma lipids and glucose, body composition measures, and blood pressure] and non-traditional risk factors [inflammatory markers and biomarkers of liver and pancreas function].nnnRESULTSnEven though patients with inflammatory bowel disease more frequently are diagnosed with cardiovascular diseases, traditional cardiovascular risk factors were not increased. Indeed, patients with inflammatory bowel disease had slightly lower plasma levels of total cholesterol and low-density lipoprotein cholesterol. Levels of inflammatory markers, particularly high-sensitivity C-reactive protein, were higher in individuals with versus without a diagnosis of inflammatory bowel disease, when assessed at a random point in time during the disease course.nnnCONCLUSIONSnThe increased risk of cardiovascular diseases in patients with inflammatory bowel disease may be linked to chronic systemic inflammation rather than to traditional cardiovascular risk factors. Further studies need to examine whether cardiovascular-preventive strategies should focus on optimising management of inflammation in patients with inflammatory bowel disease rather than focusing on traditional cardiovascular risk factors.

Authors’ response: Association between IBD and Parkinson’s disease: seek and you shall find?

Dr Weimers and colleagues have drawn attention1 to the possibility that our recently published observation of an association between IBD and Parkinson’s disease (PD) in a nationwide Danish cohort study2 may reflect surveillance bias.nnIn a recently published Swedish cohort study, Dr Weimers and colleagues found that adjusting for number of healthcare visits during follow-up of patients with IBD attenuated the risk of developing PD markedly.3 They also found that the risk of future PD was …

Maternal Antibiotic Use During Pregnancy and Type 1 Diabetes in Children—A National Prospective Cohort Study

Prenatal prescription of antibiotics is common but may perturb the composition of the intestinal microbiota in the offspring. In childhood the latter may alter the developing immune system to affect the pathogenesis of type 1 diabetes (1). Previous epidemiological studies reported conflicting results regarding the association between early exposure to antibiotics and childhood type 1 diabetes (2,3). Here we investigated the association in a Danish register setting.nnThe Danish National Birth Cohort (DNBC) provided data from 100,418 pregnant women recruited between 1996 and 2002 and their children born between 1997 and 2003 ( n = 96,840). The women provided information on exposures during and after pregnancy. Antibiotic prescription during pregnancy was obtained from the Danish National Prescription Registry (anatomical therapeutic chemical code J01), and type 1 diabetes diagnoses (diagnostic codes DE10 and DE14) during childhood and adolescence were obtained from the Danish National Patient Register. The children were followed until 2014 (mean follow-up time 14.3 years [range 11.5–18.4 years, SD 1.4]). We excluded ( n = 4,828) twins and triplets, children born before gestational week 26, children weighing <500 g at birth, and stillbirths, leaving 92,012 children for unadjusted analyses. Socioeconomic status, parity, maternal diabetes, smoking …