Hygiene Hypothesis: Is the Evidence the Same All Over the World?
Hygiene Hypothesis: Is the Evidence the Same All Over the World?
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DOI：
10.1159/000442922
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Ko, Yanna
中科院分区：
文献类型：
--
作者：
Leong, Rupert W.;Mitrev, Nikola;Ko, Yanna
背景资料：卫生假说是指现代生活条件是导致免疫相关疾病发病率增加的原因，包括炎症性肠病（IBD）的发展。改善卫生可能导致肠道微生物群多样性和生态失调减少，这可能是IBD发展的原因。关键信息：根据卫生假说，IBD的发病率在世界发展中地区有很好的记录。然而，卫生假说是否适用于全世界，这一点还不得而知。卫生不容易衡量，需要使用替代标记。其中包括区域数据，如一国的国内生产总值或个人的富裕程度或感染风险因素。一项对澳大利亚白人IBD受试者与从中东到澳大利亚的移民进行的比较病例对照研究发现，两个人群的环境风险因素不同。在澳大利亚高加索人中，与布洛芬相关的环境风险因素与IBD的发展不再相关。鉴于该国的高度富裕，几代人都有很高的卫生标准。然而，来自较不富裕国家的移民暴露于与异戊二烯相关的环境因素，患IBD的风险增加，特别是在富裕国家出生的第二代移民中。不同的风险因素包括儿童时期使用抗生素增加了发达社会中IBD的风险，但却是移民中IBD的风险因素。在印度，发现与感染相关的风险因素与溃疡性结肠炎的发展呈正相关，而不是保护性的。结论：卫生假说并不适用于全世界所有人口，在经历日益富裕或从较不富裕国家向较富裕国家移民的社会中最为相关。本综述研究了来自世界各地的数据，这些数据将卫生假说与IBD的发展联系起来，特别是富裕国家与不富裕国家的数据所产生的不同结果。(C)2016 S. Karger AG，巴塞尔
Background: The hygiene hypothesis refers to where modern living conditions are responsible for the increasing incidences of immune-related diseases including the development of inflammatory bowel diseases (IBD). Improved hygiene may result in decreased enteric microbiota diversity and dysbiosis, which may be responsible for the development of IBD. Key Messages: The rising incidence of IBD is well documented in developing regions of the world, in accordance with the hygiene hypothesis. What is unknown, however, is whether the hygiene hypothesis is applicable all over the world. Hygiene cannot be easily measured and proxy markers need to be used. These include regional data such as a country's gross domestic product or an individual's affluence or exposure to infection risk factors. A comparative case-control study of Caucasian Australian IBD subjects versus migrants from the Middle East to Australia identified that environmental risk factors are different in the 2 populations. Among Australian Caucasians, hygiene-related environmental risk factors are no longer relevant in the development of IBD. Given the country's high affluence, there has been high hygienic standard for several generations. However, migrants from less affluent countries exposed to hygiene-related environmental factors are at increased risks of developing IBD, especially in the second generation migrants born in the affluent country. Divergent risk factors include the use of antibiotics in childhood increasing the risk of IBD in developed societies but being a risk factor for developing IBD in migrants. In India, risk factors associated with infections were found to be positively associated with the development of ulcerative colitis, rather than protective. Conclusions: The hygiene hypothesis is not applicable to all populations worldwide, being most relevant in societies undergoing increasing affluence or following migration from less to more affluent countries. This review examines data from around the world that link the hygiene hypothesis with the development of IBD and in particular the divergent results arising from data from affluent countries versus less-affluent countries. (C) 2016 S. Karger AG, Basel