Inflamm Bowel Dis Volume 21, Number 8, August 2015
being 4.6 per 105 for ulcerative colitis (UC) and 3.2 per 105 for Crohn’s disease (CD) during this period. However, when we check out the annual incidence each year, we can find that the incidence of both UC and CD actually showed a trend of decrease during this period: UC decreased from 5.0 per 105 in 2006 to 4.2 in 2012, and CD decreased from 3.6 per 105 in 2006 to 3.1 in 2012. This suggests a dramatic increase occurred before 2006, which is in striking contrast for the dramatic increase of UC from about 0.3 per 105 during 1986 to 1990 to 3.1 during 2001 to 2005 and CD from about 0.1 per 105 during 1986 to 1990 to 1.3 during 2001 to 2005 as discussed in this article. Putting together, these results suggested a dramatic increase of IBD in Korea at around 2000 but a levelling off or even decrease recently. This abrupt change would suggest the critical role of some environmental factors. Evidence collected by the author suggested dietary chemicals such as saccharin and sucralose may have played important causative role in IBD.2 Multiple countries showed remarkable increase of IBD shortly after the approval of sucralose. Again, the dramatic increase of IBD around 2000 was in accordance with the approval of sucralose as food additives in Korea in 2000. Not only Korea, there were also multiple reports showing decline of IBD in Canada,3 the first country that approved the use of sucralose. Compelling evidences are accumulating showing food additives, such as saccharin, sucralose, etc, may increase the risk of diabetes, colitis, and even obesity through the change in gut microbiota.4,5 Therefore, the possible link between dietary chemicals and IBD would be worthwhile for further study.
Xiaofa Qin, MD, PhD GI Biopharam Inc., Westfield, New Jersey
REFERENCES 1. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in Korea, 2006-2012: a nationwide population-based study. Inflamm Bowel Dis. 2015;21:623–630. 2. Qin X. Etiology of inflammatory bowel disease: a unified hypothesis. World J Gastroenterol. 2012;18:1708–1722. 3. Qin X. How to explain recent multiple reports on the decline of inflammatory bowel disease in Canada. Can J Gastroenterol Hepatol. 2014;28:620.
Letters to the Editor
4. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514:181–186. 5. Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519:92–96.
Increased Incidence of Inflammatory Bowel Disease in Korea May Not Be Explained by Food Additives To the Editor: The author of the letter1 suggested a causal link between recent increase of inflammatory bowel disease (IBD) in Korea and food additives such as sucralose and saccharine. Although it is apparent that incidence of IBD rapidly increased from findings of our report,2 it seems that increase had already begun before mid 1980s. From 1986–1990 to 2000–2006, incidence had increased 10-folds (0.3–3.1 per 100,000) for ulcerative colitis and 13-folds (0.1–1.3 per 100,000) for Crohn’s disease. In the meanwhile, sucralose was approved in 2000, and saccharine was not permitted as a food ingredient from 1992 to 2011. These timelines of food additive regulation do not coincide with the change of IBD incidence in Korea. Some studies suggest patients with IBD have a higher dietary intake of food additives, sucrose, and refined carbohydrates.3–5 However, several data from Korea do not support these findings; from 1998 to 2009, sugar consumption in the nation was only modestly increased from 24 to 29 kg per person. Although IBD incidence in Korea is highest among Asian countries, sugar consumption is not much higher than in other Asian countries. Although we do not know consumption amount of food additives, a study points out relatively low risk of food additive amount in Korean food.6 Recent increase of IBD incidence in Asian region suggests environmental The author has no conflicts of interest to disclose. Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000480 Published online 2 July 2015.
and lifestyle factors play an important role. However, current data do not provide clues or evidences that confirm food additives may play a key role in increase of IBD incidence in Korea.
Hyeong Sik Ahn, MD, PhD Department of Preventive Medicine Korea University Seoul, Korea
REFERENCES 1. Qin X. How to explain the dramatic increase around 2000 but recent leveling off of inflammatory bowel disease in Korea? Inflamm Bowel Dis. 2015;21:E16–E17. 2. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in korea, 20062012: a nationwide population-based study. Inflamm Bowel Dis. 2015;21:623–630. 3. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106:563–573. 4. Andersen V, Olsen A, Carbonnel F, et al. Diet and risk of inflammatory bowel disease. Dig Liver Dis. 2012; 44:185–194. 5. Qin X. Food additives: possible cause for recent remarkable increase of inflammatory bowel disease in children. J Pediatr Gastroenterol Nutr. 2012;54:564–576. 6. Kim SD, Moon HK, Lee JH, et al. Assessment of estimated daily intakes of artificial sweeteners from non-alcoholic beverages in children and adolescents. J Korean Soc Food Scinutr. 2014;43:1304–1316.
Comments on Measures of Obesity and Risk of Crohn’s Disease and Ulcerative Colitis To the Editor: We read with interest the report by Khalilli et al,1 which confirmed an association between obesity at age 18, obesity at baseline, obesity in the visit before developing Crohn’s, and finally weight gain between weight at age 18 years and baseline in the risk of developing Crohn’s disease a median of 9.7 years after enrollment into the study. The latter 2 associations were of borderline statistical significance. None of these features were associated with the risk of developing ulcerative colitis. The authors have no conflict of interest to disclose. Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000494 Published online 24 June 2015.
www.ibdjournal.org |
Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
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being 4.6 per 105 for ulcerative colitis (UC) and 3.2 per 105 for Crohn’s disease (CD) during this period. However, when we check out the annual incidence each year, we can find that the incidence of both UC and CD actually showed a trend of decrease during this period: UC decreased from 5.0 per 105 in 2006 to 4.2 in 2012, and CD decreased from 3.6 per 105 in 2006 to 3.1 in 2012. This suggests a dramatic increase occurred before 2006, which is in striking contrast for the dramatic increase of UC from about 0.3 per 105 during 1986 to 1990 to 3.1 during 2001 to 2005 and CD from about 0.1 per 105 during 1986 to 1990 to 1.3 during 2001 to 2005 as discussed in this article. Putting together, these results suggested a dramatic increase of IBD in Korea at around 2000 but a levelling off or even decrease recently. This abrupt change would suggest the critical role of some environmental factors. Evidence collected by the author suggested dietary chemicals such as saccharin and sucralose may have played important causative role in IBD.2 Multiple countries showed remarkable increase of IBD shortly after the approval of sucralose. Again, the dramatic increase of IBD around 2000 was in accordance with the approval of sucralose as food additives in Korea in 2000. Not only Korea, there were also multiple reports showing decline of IBD in Canada,3 the first country that approved the use of sucralose. Compelling evidences are accumulating showing food additives, such as saccharin, sucralose, etc, may increase the risk of diabetes, colitis, and even obesity through the change in gut microbiota.4,5 Therefore, the possible link between dietary chemicals and IBD would be worthwhile for further study.
Xiaofa Qin, MD, PhD GI Biopharam Inc., Westfield, New Jersey
REFERENCES 1. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in Korea, 2006-2012: a nationwide population-based study. Inflamm Bowel Dis. 2015;21:623–630. 2. Qin X. Etiology of inflammatory bowel disease: a unified hypothesis. World J Gastroenterol. 2012;18:1708–1722. 3. Qin X. How to explain recent multiple reports on the decline of inflammatory bowel disease in Canada. Can J Gastroenterol Hepatol. 2014;28:620.
Letters to the Editor
4. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514:181–186. 5. Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519:92–96.
Increased Incidence of Inflammatory Bowel Disease in Korea May Not Be Explained by Food Additives To the Editor: The author of the letter1 suggested a causal link between recent increase of inflammatory bowel disease (IBD) in Korea and food additives such as sucralose and saccharine. Although it is apparent that incidence of IBD rapidly increased from findings of our report,2 it seems that increase had already begun before mid 1980s. From 1986–1990 to 2000–2006, incidence had increased 10-folds (0.3–3.1 per 100,000) for ulcerative colitis and 13-folds (0.1–1.3 per 100,000) for Crohn’s disease. In the meanwhile, sucralose was approved in 2000, and saccharine was not permitted as a food ingredient from 1992 to 2011. These timelines of food additive regulation do not coincide with the change of IBD incidence in Korea. Some studies suggest patients with IBD have a higher dietary intake of food additives, sucrose, and refined carbohydrates.3–5 However, several data from Korea do not support these findings; from 1998 to 2009, sugar consumption in the nation was only modestly increased from 24 to 29 kg per person. Although IBD incidence in Korea is highest among Asian countries, sugar consumption is not much higher than in other Asian countries. Although we do not know consumption amount of food additives, a study points out relatively low risk of food additive amount in Korean food.6 Recent increase of IBD incidence in Asian region suggests environmental The author has no conflicts of interest to disclose. Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000480 Published online 2 July 2015.
and lifestyle factors play an important role. However, current data do not provide clues or evidences that confirm food additives may play a key role in increase of IBD incidence in Korea.
Hyeong Sik Ahn, MD, PhD Department of Preventive Medicine Korea University Seoul, Korea
REFERENCES 1. Qin X. How to explain the dramatic increase around 2000 but recent leveling off of inflammatory bowel disease in Korea? Inflamm Bowel Dis. 2015;21:E16–E17. 2. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in korea, 20062012: a nationwide population-based study. Inflamm Bowel Dis. 2015;21:623–630. 3. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106:563–573. 4. Andersen V, Olsen A, Carbonnel F, et al. Diet and risk of inflammatory bowel disease. Dig Liver Dis. 2012; 44:185–194. 5. Qin X. Food additives: possible cause for recent remarkable increase of inflammatory bowel disease in children. J Pediatr Gastroenterol Nutr. 2012;54:564–576. 6. Kim SD, Moon HK, Lee JH, et al. Assessment of estimated daily intakes of artificial sweeteners from non-alcoholic beverages in children and adolescents. J Korean Soc Food Scinutr. 2014;43:1304–1316.
Comments on Measures of Obesity and Risk of Crohn’s Disease and Ulcerative Colitis To the Editor: We read with interest the report by Khalilli et al,1 which confirmed an association between obesity at age 18, obesity at baseline, obesity in the visit before developing Crohn’s, and finally weight gain between weight at age 18 years and baseline in the risk of developing Crohn’s disease a median of 9.7 years after enrollment into the study. The latter 2 associations were of borderline statistical significance. None of these features were associated with the risk of developing ulcerative colitis. The authors have no conflict of interest to disclose. Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000494 Published online 24 June 2015.
www.ibdjournal.org |
Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
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