Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University Medical School, 3755 Cote St Catherine Rd, Room E110, Montreal, QC, H3T 1E2, Canada.
Clin J Gastroenterol. 2020 Apr;13(2):139-152. doi: 10.1007/s12328-019-01037-y. Epub 2019 Aug 26.
The inflammatory bowel diseases, Crohn's and ulcerative colitis have increased in incidence and prevalence from the mid-eighteen to the late nineteen centuries. From then to the current twenty-first century there has been a more rapid expansion of these disease to areas previously experiencing low rates. This latter expansion coincides with the current obesity pandemic which also began toward the end of the last century. Although the two diseases have radically different frequencies, there are interesting links between them. Four areas link the diseases. On an epidemiological level, IBD tends to follow a north-south gradient raising the importance of vitamin D in protection. Obesity has very weak relationship with latitude, but both diseases follow adult lactase distributions colliding in this plane. Is it possible that obesity (a low vitamin D condition with questionable response to supplements) reduces effects in IBD? On a pathogenic level, pro-inflammatory processes mark both IBD and obesity. The similarity raises the question of whether obesity could facilitate the development of IBD. Features of the metabolic syndrome occur in both, with or without obesity in IBD. The fourth interaction between the two diseases is the apparent effect of obesity on the course of IBD. There are suggestions that obesity may reduce the efficacy of biologic agents. Yet there is some suggestion also that obesity may reduce the need for hospitalization and surgery. The apparent co-expansion of both obesity and IBD suggests similar environmental changes may be involved in the promotion of both.
炎症性肠病，包括克罗恩病和溃疡性结肠炎，其发病率和患病率在 19 世纪中叶至晚期呈上升趋势。从那时到 21 世纪，这些疾病在以前发病率较低的地区迅速蔓延。这种后来的扩张与当前的肥胖症大流行相吻合，后者也始于上世纪末。尽管这两种疾病的发病率有很大差异，但它们之间存在着有趣的联系。有四个领域将这两种疾病联系在一起。在流行病学层面，IBD 往往呈南北梯度分布，这凸显了维生素 D 在保护中的重要性。肥胖与纬度的关系非常微弱，但这两种疾病都与成人乳糖酶分布相吻合，在这个层面上存在交叉。肥胖（一种维生素 D 水平低且对补充剂反应不佳的状态）是否会降低 IBD 的疗效？在发病机制层面，促炎过程标志着 IBD 和肥胖症。这种相似性引发了肥胖是否会促进 IBD 发展的问题。代谢综合征的特征在这两种疾病中都存在，无论是否存在肥胖症。这两种疾病之间的第四个相互作用是肥胖对 IBD 病程的明显影响。有研究表明，肥胖可能会降低生物制剂的疗效。但也有一些研究表明，肥胖可能会减少住院和手术的需求。肥胖症和 IBD 的明显共同扩张表明，可能涉及相似的环境变化来促进这两种疾病的发生。
