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      Early-life diet and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts

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          Abstract

          Objective

          We assessed whether early-life diet quality and food intake frequencies were associated with subsequent IBD.

          Design

          Prospectively recorded 1-year and 3-year questionnaires in children from the All Babies in Southeast Sweden and The Norwegian Mother, Father and Child Cohort Study were used to assess diet quality using a Healthy Eating Index and intake frequency of food groups. IBD was defined as >2 diagnoses in national patient registers. Cox regression yielded HRs adjusted (aHRs) for child’s sex, parental IBD, origin, education level and maternal comorbidities. Cohort-specific results were pooled using a random-effects model.

          Results

          During 1 304 433 person-years of follow-up, we followed 81 280 participants from birth through childhood and adolescence, whereof 307 were diagnosed with IBD. Compared with low diet quality, medium and high diet quality at 1 year of age were associated with a reduced risk of IBD (pooled aHR 0.75 (95% CI=0.58 to 0.98) and 0.75 (95% CI=0.56 to 1.00)). The pooled aHR per increase of category was 0.86 (0.74 to 0.99). Pooled aHR for children 1 year old with high versus low fish intake was 0.70 (95% CI=0.49 to 1.00) for IBD, and showed association with reduced risk of UC (pooled aHR=0.46; 95% CI=0.21, 0.99). Higher vegetable intake at 1 year was associated with a risk reduction in IBD. Intake of sugar-sweetened beverages was associated with an increased risk of IBD. Diet quality at 3 years was not associated with IBD.

          Conclusion

          In this Scandinavian birth cohort, high diet quality and fish intake in early life were associated with a reduced risk of IBD.

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          Most cited references51

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          Meta-analysis in clinical trials

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            External review and validation of the Swedish national inpatient register

            Background The Swedish National Inpatient Register (IPR), also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973) but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery) and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge) Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV) was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.
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              Temporal development of the gut microbiome in early childhood from the TEDDY study

              The development of the microbiome from infancy to childhood is dependent on a range of factors, with microbial–immune crosstalk during this time thought to be involved in the pathobiology of later life diseases1–9 such as persistent islet autoimmunity and type 1 diabetes10–12. However, to our knowledge, no studies have performed extensive characterization of the microbiome in early life in a large, multi-centre population. Here we analyse longitudinal stool samples from 903 children between 3 and 46 months of age by 16S rRNA gene sequencing (n = 12,005) and metagenomic sequencing (n = 10,867), as part of the The Environmental Determinants of Diabetes in the Young (TEDDY) study. We show that the developing gut microbiome undergoes three distinct phases of microbiome progression: a developmental phase (months 3–14), a transitional phase (months 15–30), and a stable phase (months 31–46). Receipt of breast milk, either exclusive or partial, was the most significant factor associated with the microbiome structure. Breastfeeding was associated with higher levels of Bifidobacterium species (B. breve and B. bifidum), and the cessation of breast milk resulted in faster maturation of the gut microbiome, as marked by the phylum Firmicutes. Birth mode was also significantly associated with the microbiome during the developmental phase, driven by higher levels of Bacteroides species (particularly B. fragilis) in infants delivered vaginally. Bacteroides was also associated with increased gut diversity and faster maturation, regardless of the birth mode. Environmental factors including geographical location and household exposures (such as siblings and furry pets) also represented important covariates. A nested case–control analysis revealed subtle associations between microbial taxonomy and the development of islet autoimmunity or type 1 diabetes. These data determine the structural and functional assembly of the microbiome in early life and provide a foundation for targeted mechanistic investigation into the consequences of microbial–immune crosstalk for long-term health.
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                Author and article information

                Journal
                Gut
                Gut
                gutjnl
                gut
                Gut
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0017-5749
                1468-3288
                April 2024
                30 January 2024
                : 73
                : 4
                : 590-600
                Affiliations
                [1 ] departmentDepartment of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy , Ringgold_3570University of Gothenburg , Gothenburg, Sweden
                [2 ] departmentDivision of Pediatrics, Biomedical and Clinical Sciences , Linköping University , Linköping, Sweden
                [3 ] Crown Princess Victoria Children’s Hospital, Region Östergötland , Linköping, Sweden
                [4 ] departmentDepartment of Food Safety , Norwegian Institute of Public Health , Oslo, Norway
                [5 ] departmentDepartment of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy , Ringgold_3570University of Gothenburg , Gothenburg, Sweden
                [6 ] departmentBioinformatics and Data Centre, Sahlgrenska Academy , Ringgold_3570University of Gothenburg , Gothenburg, Sweden
                [7 ] departmentDepartment of Pediatric Research, Faculty of Medicine , Ringgold_6305University of Oslo , Oslo, Norway
                [8 ] departmentChildren’s Center , Ringgold_155272Oslo University Hospital , Oslo, Norway
                [9 ] departmentDepartment of Pediatric Gastroenterology , Queen Silvia Children’s Hospital , Gothenburg, Sweden
                Author notes
                [Correspondence to ] Annie Guo, Department of Pediatrics, University of Gothenburg, Gothenburg 405 30, Sweden; annie.guo@ 123456gu.se

                KS and KM are joint senior authors.

                Author information
                http://orcid.org/0000-0003-4635-1183
                http://orcid.org/0000-0003-1695-5234
                http://orcid.org/0000-0001-6315-7134
                http://orcid.org/0000-0002-9093-2826
                http://orcid.org/0000-0002-8184-9609
                http://orcid.org/0000-0001-7826-8646
                http://orcid.org/0000-0003-2285-8713
                Article
                gutjnl-2023-330971
                10.1136/gutjnl-2023-330971
                10958293
                38290832
                651232e7-a8b1-4fd2-b3b6-4fe5e03c8bc6
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 23 August 2023
                : 23 December 2023
                Funding
                Funded by: Henning and Johan Throne-Holst Foundation;
                Award ID: 0000
                Funded by: The Swedish Society for Medical Research;
                Award ID: S20-0007 TG-23-0002
                Funded by: Barndiabetesfonden (Swedish Child Diabetes Foundation);
                Award ID: 0000
                Funded by: The Swedish Research Council;
                Award ID: 2020-01980
                Funded by: Swedish Research Council;
                Award ID: K2005-72X-11242-11A
                Award ID: K2008-69X-20826-01-4
                Funded by: Swedish Council for Working Life and Social Research;
                Award ID: FAS2004-1775
                Award ID: FAS2004–1775
                Funded by: JDRF Wallenberg Foundation;
                Award ID: K 98-99D-12813-01A
                Funded by: Medical Research Council of Southeast Sweden;
                Award ID: 0000
                Funded by: ALF;
                Award ID: ALFGBG-915661
                Funded by: Joanna Cocozza Foundation;
                Award ID: 0000
                Categories
                Inflammatory Bowel Disease
                1506
                1612
                2312
                Original research
                Custom metadata
                unlocked
                press-release

                Gastroenterology & Hepatology
                ibd,diet,paediatric gastroenterology,nutrition in paediatrics
                Gastroenterology & Hepatology
                ibd, diet, paediatric gastroenterology, nutrition in paediatrics

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