Heilsa - Sjúkrakassagrunnurin
Inflammatory Bowel Disease in the Faroe Islands
Deildin fyri Arbeiðs- og Almannaheilsu
Elsebeth Lynge, Kári Rubek-Nielsen, Pia Munkholm, Pál Weihe og Johan Burisch
Stuðul úr Granskingargrunninum:
Inflammatory bowel diseases (IBDs) are chronic disorders of relapsing nature mainly encompassing Crohn’s disease (CD) and ulcerative colitis (UC). Worldwide, the incidence of CD is between 0 and 20 per 100,000, and for UC, between 0 and 24 per 100,000. IBD was previously considered a disease of Western countries, but more recently it has been observed in many places of the world, with for instance a rapid increase in Japan.
IBD incidence has been examined in Faroese population-based studies for the periods 1964-83, 1981-1988 and 2005-2009. In 2010 and 2011, it was investigated within the European Crohn’s & Colitis Organization’s Epidemiological Committee study (ECCO-EpiCom), where the highest IBD incidence in the world was found in the Faroe Islands at 84 per 100,000 person-years.
The etiology of IBD is unknown, but it is believed to occur in genetically susceptible individuals, when exposed to environmental risk factors or triggers. The increasing incidence in the Faroe Islands could indicate a response to changing environmental exposures.
The aim is to explore the etiology of IBD on the Faroe Islands by:
1) Determining the IBD incidence in the Faroe Islands by sex and birth cohorts;
2) Determining the environmental risk factors for IBD;
3) Investigating the IBD incidence in Faroese citizens moving to Denmark
This epidemiological study is based on patient registrations from the National Faroese Patient Register and environmental exposures from the Faroese mother-child cohorts, the Children’s Health and the Environment in the Faroes (CHEF) project. Population data will be gathered from the Faroe Islands and Denmark.
The Faroe Islands is an ideal place for epidemiological studies due to the well-defined population, limited migration, and a high quality health care system. Furthermore, the exceptionally high incidence of IBD poses a challenge. A familial predisposition in IBD could not alone explain the dramatic increase in incidence over time, pointing at potential environmental influences deriving from for instance changing dietary habits. The unique setting of the Faroe Islands with a high-risk population, stresses the possibility for groundbreaking research with the potential to benefit not only the population of the Faroe Islands, but also nations worldwide.
Inflammatory bowel disease (IBD) is primarily comprised of the chronic inflammatory disorders, Crohn’s disease (CD) and ulcerative colitis (UC). These immune mediated diseases of unknown aetiology are assumedly caused by a combination of genetic and environmental factors. Previous studies of shorter time periods have pointed at a high incidence of IBD in the Faroe Islands.
In the first paper, the incidence of IBD in the Faroe Islands from 1960-2014 is described. The incidence pattern has changed drastically, from being relatively low in the early period from 1960-79 with an age-standardised incidence rate at 7 per 100,000 PY (ESP) until 2000 where the incidence increased considerably. By the end of the study period (2014), the Faroe Islands had the highest recorded incidence of IBD in the world at 74 per 100,000 PY (ESP). In total, 664 new cases of IBD were diagnosed. These were distributed as 113 CD patients, 417 with UC and 134 with IBD unclassified (IBDU). Paediatric-onset IBD was diagnosed in 51 patients. The overwhelming emergence of these diseases occurring over five decades with a recent steep increase is likely to be explained by environmental changes over genetics.
In the second paper we investigated the incidence of IBD in Faroese first-, second- and third-generation immigrants to Denmark, as many move to Denmark for work or education. In Denmark the incidence of IBD is lower and the aim was to examine whether the immigrants adopt the incidence of their new country. We found that first-generation immigrants have a higher incidence of IBD compared to Danes with an excess risk for UC, but none for CD. The excess risk of UC changes after the first 10 years in Denmark for first-generation immigrants, from being almost doubled to resembling the Danish level after 10 years. These findings underline the significance of the environment in the development of IBD, and especially of UC.
The third paper explored environmental risk factors for IBD in the Faroe Islands. We retrieved data mainly from the Children’s Health and the Environment in the Faroes (CHEF) project on lifestyle factors such as smoking, alcohol consumption, and intake of pilot whale, blubber and fish. Furthermore, data on marine toxicants were also included. The incidence of IBD and UC was calculated as the rate ratio (RR) with 95% confidence interval (CI) for lifestyle factors. Regarding the toxicants, persons were divided into tertiles with the RR calculated for persons in the highest exposure tertile compared to the lowest. In total, 5698 persons were included, of which 37 were diagnosed with IBD. A statistically significant association was found for smoking and IBD and for one pollutant (p,p’-DDT). Our study did not indicate that the high incidence is caused by the intake of traditional food, nor by the environmental pollutant found in this food.
Ph.d.-ritgerðin varð vard á Københavns Universitet 5.3.2020.
Greinar The Faroese IBD Study: Incidence of Inflammatory Bowel Diseases Across 54 Years of Population-based Data. Høvundarnir eru Turid Hammer og Kári Rubek Nielsen, Pia Munkholm, Johan Burisch og Elsebeth Lynge.
Inflammatory bowel diseases in Faroese-born Danish residents and their offspring: further evidence of the dominant role of environmental factors in IBD development. Høvundarnir eru Turið Hammer, Søren Nymand Lophaven, Kári Rubek-Nielsen, Marianne von Euler-Chelpin, Pál Weihe, Pia Munkholm, Johan Burisch og Elsebeth Lynge.
Dietary risk factors for inflammatory bowel diseases in a high-risk population: Results from the Faroese IBD study. Høvundar: T Hammer, S Nymand Lophaven, K Rubek Nielsen K Rubek Nielsen, M Skaalum Petersen, P Munkholm, P Weihe, J Burisch, E Lynge Almenvísindalig kunning
2015: Featured in article in UEG Education, May 2015: https://www.ueg.eu/education/latest-news/article/article/wake-up-europe-its-world-ibd-day/
2016: Article at Gransking.fo, April 2016 [in Faroese]: https://www.gransking.fo/fo/tilfeingi/tidindi/grein-um-tarmbrunasjukur-i-foroyum-1960-2014/
2017: Article at Gransking.fo, February 2017 [in Faroese]: https://www.gransking.fo/fo/tilfeingi/tidindi/tittleiki-av-tarmbruna-hja-foroyingum-broytist-i-danmark/
2017: Article at Healio.com, March 8: http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7Bf944d26a-730f-43ab-9760-d0bf37e6cff3%7D/immigrant
2017: Invited Editorial. Lamba MJ, Tharayil, Gearry RB.Inflammatory bowel disease risk reduction after migration – are early life events important? Aliment Pharmacol Ther. 2017 May;45(10):1367-1368. doi: 10.1111/apt.14034.
2018: Featured in Supplementary appendix, a supplement to: Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390:2769-2778. https://ars.els-cdn.com/content/image/1-s2.0-S0140673617324480-mmc1.pdf
2017 (sep.): Interview in Góðan morgun Føroyar
2019 (dec.): Interview in Útvarpstíðini
2014: EpiCom Workshop, European Crohn’s and Colitis Organisation (ECCO) Congress Copenhagen - invited speaker
2015: 10th Congress of ECCO, February 19-21, Barcelona, Spain - oral presentation of submitted abstract
2015: Digestive Disease Week® (DDW) – the abstract, with Dr. Kári Rubek Nielsen as co-first author, was submitted to DDW2015 and accepted as a poster with presentation
2016: Colitis-Crohn Foreningen General Assembly, Aalborg, Denmark, 9th April 2016 - presentation of grant winning project
2017: 12th Congress of ECCO, February 16-18, Barcelona, Spain – poster presentation of submitted abstract at guided poster tour
Several journal club presentations at Centre for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark and at the National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
2017: Participation in research day with poster presentation at the National Hospital of the Faroe Islands on May 18, 2017.
2017: Participation with exhibition and lectures around the Faroe Islands within the research initiative entitled Vísindavøka and Vísindavøka á ferð organized by the Faroese Research Council together with other Faroese research institutions
2019: Presentation entitled Inflammatory bowel diseases in the Faroe Islands at Research afternoon in the Centre of Health Sciences (CHS) at the University of the Faroe Islands (Dr. Kári Rubek Nielsen presented my work as I was abroad)