Abstract

A multifaceted ecological approach to explore links between environmental factors and the epidemiology of disorders of gut-brain interaction

Neurogastroenterol Motil. 2024 Jul 15:e14866. doi: 10.1111/nmo.14866. Online ahead of print.

 

Thomas Fairlie 1 2Ayesha Shah 1 2Reuben K Wong 3Xiucai Fang 4Uday C Ghoshal 5Purna C Kashyap 6Agata Mulak 7Yeong Yeh Lee 8 9Ami D Sperber 10Natasha Koloski 1 2 11Naomi Moy 1Nicholas J Talley 11Michael P Jones 12Gerald Holtmann 1 2

 
     

Author information

1Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

2Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.

3Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

4Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

5Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, India.

6Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

7Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.

8School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.

9GI Function & Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.

10Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

11School of Medicine and Public Health, and Hunter Medical Research Institute, The University of Newcastle, Callaghan, Newcastle, Australia.

12Department of Psychology, Macquarie University, Ryde, New South Wales, Australia.

Abstract

Background: Disorders of gut-brain interaction (DGBI) are characterized by debilitating symptoms not explained by structural or biochemical abnormalities. While functional conditions present with complex, likely heterogeneous pathophysiology, we aimed to investigate if proxy measures of sociocultural and environmental factors are associated with the prevalence of various DGBI in populations across the world.

Methods: We performed an ecological study utilizing peer-reviewed published datasets reporting for 26 countries prevalence rates of DGBI (Rome Foundation Global Epidemiology Study, RFGES), with six independent variables: Helicobacter pylori prevalence and household size as proxy measures for orofecal infections, gross domestic product per capita (GDP), and median age as a proxy measures for socioeconomic development, density of fast food outlets (FFO) per 100,000 population as proxy measure for processed food exposure, and suicide mortality rate per 100,000 people, and world happiness scores were used as a proxy for psychological stress. The data were retrieved from publicly accessible datasets (United Nations, CIA World Factbook, World Bank, World Happiness Report, commercial/financial reports of a global FFO chain). We used linear regression to assess variables in univariate and multivariate analysis and report standardized β coefficients with 95% confidence intervals (CI).

Key results: The regression model revealed that the overall prevalence of DGBI was inversely associated with both GDP per capita (β = -0.57, 95% CI: -0.92, -0.22, p = 0.002) and happiness scores (β = -0.433 95% CI: 0.821, -0.065, p = 0.023), while being positively associated with H. pylori prevalence (β = 0.40, 95% CI: 0.008, 0.81, p = 0.046). The prevalence of functional constipation (FC) was also inversely associated with GDP per capita (β = -0.50, 95% CI: -0.86, -0.13, p = 0.01) and happiness scores (β = -0.497, 95% CI: -0.863, -0.132, p = 0.01), while being positively associated with H. pylori prevalence (β = 0.53, 95% CI: 0.16, 0.91, p = 0.007). The Multivariate model analysis revealed that combining the factors of H. pylori prevalence, suicide rate, household size and happiness scores showed statistically significant association with FC (p = 0.039). Household size (β = -0.43, 95% CI: -0.82, 0.038, p = 0.033) and suicide rates (β = 0.55, 95% CI: 0.19, 0.90, p = 0.004) were statistically significantly associated with functional diarrhea. Irritable bowel syndrome (IBS) was associated with GDP per capita (β = -0.40, 95% CI: -0.79, -0.014, p = 0.043) and happiness scores (β = -0.390, 95% CI: -0.778, -0.003, p = 0.049).

Conclusions & inferences: Utilizing publicly available data, the prevalence of DGBI across diverse countries is linked to various socio-cultural and environmental factors. Collectively, the data suggests that the prevalence of DGBI is increased in less prosperous regions of the world.

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