Scandinavian Journal of Gastroenterology. 2014; 49: 1268–1269
LETTER TO THE EDITOR
Why pediatric inflammatory bowel disease (IBD) in Sweden shared similar trend of change as general population IBD in Denmark but not pediatric IBD in Norway?
XIAOFA QIN GI Biopharma, Inc., NJ, USA
To the Editor In 2009, this journal published a study by Perminow et al. with information on pediatric inflammatory bowel disease (IBD) in South-Eastern Norway during 1990–2007 [1], which showed a dramatic increase of pediatric IBD in Oslo area during 2005–2007. Last year, Malmborg et al. published a paper with information on pediatric IBD in Northern Stockholm County, Sweden during the same period [2], but it showed a plateau of pediatric IBD in Stockholm during 2002–2007, with a dramatic increase before that. During the last decade, I found more and more evidence suggesting dietary chemicals like some artificial sweeteners may have played important causative role in IBD, through their inhibition on gut bacteria and the resultant impairment in inactivation of digestive proteases and damage of the mucus layer and underlying gut tissue [3]. It provided simple explanations for many puzzles in IBD. I found the discrepancies between pediatric IBD in Norway and Sweden may also be explained by the use of some artificial sweeteners [4]. Studies showed that cyclamate was heavily used in Sweden and Denmark but very low in Norway. In contrast, sucralose was heavily used in Norway but low in Sweden and Denmark. In 2004, European Union approved marketing of sucralose but also adopted regulation to reduce the maximum permitted level for cyclamate in soft drinks from 400 mg/l to 250 mg/l. Thus, the low use of cyclamate but heavy use of sucralose in Norway was in
accordance with the remarkable increase in pediatric IBD during 2005–2007, while the new regulations may have resulted in the plateau of overall IBD incidence in Sweden. Recently, a paper by Norgard et al. was published with information on the incidence of ulcerative colitis and Crohn’s disease in the general population in Denmark during 1995–2012 [5]. Interestingly, if we put the three studies above together (Figure 1), we can see the pediatric IBD in Northern Stockholm County, Sweden had a similar trend of change during 1995 and 2007 as IBD in the general population in Denmark but not pediatric IBD in Oslo area in SouthEastern Norway. Again, this fits into the pattern of cyclamate and sucralose use among these countries as discussed in the paper I published early [4] but would be difficult to be explained by many current popular hypotheses such as hygiene condition, vitamin D and sunshine (Stockholm shared similar latitude with Oslo but not Denmark), smoking, Mycobacterium avium subspecies paratuberculosis (MAP, which is very low in Sweden but high in Denmark and Norway), worms, etc. Up to date, the cause of IBD remains regarded by mainstream as unknown, largely because of the puzzling peculiar temporal and geographical changes. However, time and again, behind complex phenomena are some simple principles, which might be also the case for IBD. Use of several artificial sweeteners explained the peculiar epidemiological changes of IBD not only in Norway, Sweden and Demark but also in other countries like Canada, Australia, United States, Singapore, Saudi Arabia and
Correspondence: Xiaofa Qin, MD, PhD, GI Biopharma, Inc., 918 Willow Grove Road, Westfield, NJ 07090, USA. Tel: +1 908 463 7423. E-mail: [email protected]
(Received 29 June 2014; accepted 15 July 2014) ISSN 0036-5521 print/ISSN 1502-7708 online Ó 2014 Informa Healthcare DOI: 10.3109/00365521.2014.946086
30 10 25 8 20 6
15
4
10 Paediatric IBD, Sweden
2
Paediatric IBD, Norway
5
General population IBD, Denmark 0 1988
1993
1998
2003
General population IBD incidence in Denmark
Paediatric IBD incidence in Sweden and Norway
35 12
0 2008
Year Figure 1. Incidence of pediatric inflammatory bowel disease (IBD) in Northern Stockholm County of Sweden [2], pediatric IBD in Oslo area in South-Eastern Norway [1] and average of male and female IBD in the nationwide population in Denmark [5] based on the information from the corresponding papers (per 100,000).
China [3,6-10]. Here, I advocate again checking out the possible link between food additives and IBD. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
References [1] Perminow G, Brackmann S, Lyckander LG, Franke A, Borthne A, Rydning A, et al. A characterization in childhood inflammatory bowel disease, a new population-based inception cohort from South-Eastern Norway, 2005-07, showing increased incidence in Crohn’s disease. Scand J Gastroenterol 2009;44:446–56. [2] Malmborg P, Grahnquist L, Lindholm J, Montgomery S, Hildebrand H. Increasing incidence of paediatric inflammatory bowel disease in Northern Stockholm County 2002-2007. J Pediatr Gastroenterol Nutr 2013;57:29–34. [3] Qin X. Etiology of inflammatory bowel disease: a unified hypothesis. World J Gastroenterol 2012;18:1708–22.
[4] Qin X. How to explain the discordant change of ulcerative colitis and Crohn disease in adjacent or even the same regions and time periods. J Pediatr Gastroenterol Nutr 2013;57:e30. [5] Norgard BM, Nielsen J, Fonager K, Kjeldsen J, Jacobsen BA, Qvist N. The incidence of ulcerative colitis (1995-2011) and Crohn’s disease (1995-2012) - based on nationwide Danish registry data. J Crohns Colitis 2014; Epub ahead of print. [6] Qin X. When and how was the new round of increase in inflammatory bowel disease in the United States started? J Clin Gastroenterol 2014;48:564–5. [7] Qin X. Comment on: paediatric inflammatory bowel disease in a multiracial Asian country. Singapore Med J 2013;54:716. [8] Qin X. What might be the cause for the emerging inflammatory bowel disease in Saudi outpatients? Saudi J Gastroenterol 2014;20:75. [9] Qin X. Is the gap between the developed and developing countries in the incidence of inflammatory bowel disease disappearing? Gastroenterology 2013;145:912. [10] Qin X. May artificial sweeteners not sugar be the culprit of dramatic increase of inflammatory bowel disease in China? Chin Med J 2014;In press.
Copyright of Scandinavian Journal of Gastroenterology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Why pediatric inflammatory bowel disease (IBD) in Sweden shared similar trend of change as general population IBD in Denmark but not pediatric IBD in Norway?
XIAOFA QIN GI Biopharma, Inc., NJ, USA
To the Editor In 2009, this journal published a study by Perminow et al. with information on pediatric inflammatory bowel disease (IBD) in South-Eastern Norway during 1990–2007 [1], which showed a dramatic increase of pediatric IBD in Oslo area during 2005–2007. Last year, Malmborg et al. published a paper with information on pediatric IBD in Northern Stockholm County, Sweden during the same period [2], but it showed a plateau of pediatric IBD in Stockholm during 2002–2007, with a dramatic increase before that. During the last decade, I found more and more evidence suggesting dietary chemicals like some artificial sweeteners may have played important causative role in IBD, through their inhibition on gut bacteria and the resultant impairment in inactivation of digestive proteases and damage of the mucus layer and underlying gut tissue [3]. It provided simple explanations for many puzzles in IBD. I found the discrepancies between pediatric IBD in Norway and Sweden may also be explained by the use of some artificial sweeteners [4]. Studies showed that cyclamate was heavily used in Sweden and Denmark but very low in Norway. In contrast, sucralose was heavily used in Norway but low in Sweden and Denmark. In 2004, European Union approved marketing of sucralose but also adopted regulation to reduce the maximum permitted level for cyclamate in soft drinks from 400 mg/l to 250 mg/l. Thus, the low use of cyclamate but heavy use of sucralose in Norway was in
accordance with the remarkable increase in pediatric IBD during 2005–2007, while the new regulations may have resulted in the plateau of overall IBD incidence in Sweden. Recently, a paper by Norgard et al. was published with information on the incidence of ulcerative colitis and Crohn’s disease in the general population in Denmark during 1995–2012 [5]. Interestingly, if we put the three studies above together (Figure 1), we can see the pediatric IBD in Northern Stockholm County, Sweden had a similar trend of change during 1995 and 2007 as IBD in the general population in Denmark but not pediatric IBD in Oslo area in SouthEastern Norway. Again, this fits into the pattern of cyclamate and sucralose use among these countries as discussed in the paper I published early [4] but would be difficult to be explained by many current popular hypotheses such as hygiene condition, vitamin D and sunshine (Stockholm shared similar latitude with Oslo but not Denmark), smoking, Mycobacterium avium subspecies paratuberculosis (MAP, which is very low in Sweden but high in Denmark and Norway), worms, etc. Up to date, the cause of IBD remains regarded by mainstream as unknown, largely because of the puzzling peculiar temporal and geographical changes. However, time and again, behind complex phenomena are some simple principles, which might be also the case for IBD. Use of several artificial sweeteners explained the peculiar epidemiological changes of IBD not only in Norway, Sweden and Demark but also in other countries like Canada, Australia, United States, Singapore, Saudi Arabia and
Correspondence: Xiaofa Qin, MD, PhD, GI Biopharma, Inc., 918 Willow Grove Road, Westfield, NJ 07090, USA. Tel: +1 908 463 7423. E-mail: [email protected]
(Received 29 June 2014; accepted 15 July 2014) ISSN 0036-5521 print/ISSN 1502-7708 online Ó 2014 Informa Healthcare DOI: 10.3109/00365521.2014.946086
30 10 25 8 20 6
15
4
10 Paediatric IBD, Sweden
2
Paediatric IBD, Norway
5
General population IBD, Denmark 0 1988
1993
1998
2003
General population IBD incidence in Denmark
Paediatric IBD incidence in Sweden and Norway
35 12
0 2008
Year Figure 1. Incidence of pediatric inflammatory bowel disease (IBD) in Northern Stockholm County of Sweden [2], pediatric IBD in Oslo area in South-Eastern Norway [1] and average of male and female IBD in the nationwide population in Denmark [5] based on the information from the corresponding papers (per 100,000).
China [3,6-10]. Here, I advocate again checking out the possible link between food additives and IBD. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
References [1] Perminow G, Brackmann S, Lyckander LG, Franke A, Borthne A, Rydning A, et al. A characterization in childhood inflammatory bowel disease, a new population-based inception cohort from South-Eastern Norway, 2005-07, showing increased incidence in Crohn’s disease. Scand J Gastroenterol 2009;44:446–56. [2] Malmborg P, Grahnquist L, Lindholm J, Montgomery S, Hildebrand H. Increasing incidence of paediatric inflammatory bowel disease in Northern Stockholm County 2002-2007. J Pediatr Gastroenterol Nutr 2013;57:29–34. [3] Qin X. Etiology of inflammatory bowel disease: a unified hypothesis. World J Gastroenterol 2012;18:1708–22.
[4] Qin X. How to explain the discordant change of ulcerative colitis and Crohn disease in adjacent or even the same regions and time periods. J Pediatr Gastroenterol Nutr 2013;57:e30. [5] Norgard BM, Nielsen J, Fonager K, Kjeldsen J, Jacobsen BA, Qvist N. The incidence of ulcerative colitis (1995-2011) and Crohn’s disease (1995-2012) - based on nationwide Danish registry data. J Crohns Colitis 2014; Epub ahead of print. [6] Qin X. When and how was the new round of increase in inflammatory bowel disease in the United States started? J Clin Gastroenterol 2014;48:564–5. [7] Qin X. Comment on: paediatric inflammatory bowel disease in a multiracial Asian country. Singapore Med J 2013;54:716. [8] Qin X. What might be the cause for the emerging inflammatory bowel disease in Saudi outpatients? Saudi J Gastroenterol 2014;20:75. [9] Qin X. Is the gap between the developed and developing countries in the incidence of inflammatory bowel disease disappearing? Gastroenterology 2013;145:912. [10] Qin X. May artificial sweeteners not sugar be the culprit of dramatic increase of inflammatory bowel disease in China? Chin Med J 2014;In press.
Copyright of Scandinavian Journal of Gastroenterology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
