Global associations of national economic wealth are more robust with inflammatory bowel diseases than with obesity.

The inflammatory bowel diseases consisting of Crohn's and ulcerative colitis have expanded into previously low incidence areas of the world. The spread follows the relatively recent pandemic of global obesity. Pathological relations have been proposed between these two diseases. Both inflammatory bowel diseases and obesity originated in wealthier western societies marked by high gross domestic product per capita. The pathogenic influence of national wealth on the inflammatory bowel diseases has been recognized but are less clear with obesity. Parallel correlations of national wealth with obesity would further strengthen relations between these two diseases. Alternatively, diverging relations could suggest that obesity is less dependent on wealth. As such it would supports another earlier hypothesis that obesity depends on adoption of western diet which precedes national acquisition of wealth. Previously ecological modifiers of global disease patterns, including latitude and lactose digestion status have shown different influences on IBD compared with obesity. We evaluate. the influence of the Gross Domestic Product on these two diseases taking into consideration the former's relationship with ecological markers. Patterns of correlations could suggest contributing mechanisms how these ecological parameters influence some disease distributions. The literature and internet were searched for national rates of obesity, inflammatory bowel diseases, national gross domestic product per capita and national lactase distribution rates. National average latitudes were calculated previously. Pearson correlations were used to compare variables in three regions; global, European and Asian theaters. SAS statistical package was used and statistical significance was accepted at p < 0.05. Globally and in Europe correlations of gross domestic product were moderate and significant r = 0.55 and r = 0.6 respectively with Crohn's disease but weaker with ulcerative colitis. The results were negligible in Asia. Obesity was weakly correlated with gross domestic product globally r = 0.32 and negligible in Europe and Asia. In addition, gross domestic product was moderately correlated with latitude r = 0.6, and inversely with lactase non persistence r = -0.6 both globally and in Europe. This relationship is similar to that with inflammatory bowel diseases, but less related to obesity. Overall results suggest unequal effect of national wealth and industrialization on obesity and inflammatory bowel diseases. It has been suggested that western type diet precedes full industrialization and this could promote obesity.

Vitamin B12 deficiency in inflammatory bowel disease: prevalence, risk factors, evaluation, and management.

BACKGROUND: Management of vitamin B(12) (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) is often not evidenced-based because of uncertainty on whether it causes enough malabsorption to result in clinical disease. This systematic review examines whether IBD predisposes to Cbl deficiency. We provide an approach to the management of abnormal Cbl values in IBD based on current literature and consensus-based guidelines. METHODS: An extensive search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 42 articles with a total of 3732 patients evaluating Cbl deficiency in IBD. RESULTS: Crohn's disease without ileal resection, regardless of disease location in the ileum, did not increase the risk for Cbl deficiency. Ileal resections greater than 30 cm were associated with Cbl deficiency in Crohn's disease, whereas those less than 20 cm were not. The effects of 20 to 30 cm resections were inconsistent. Ulcerative colitis did not predispose to deficiency. All studies failed to use confirmatory biomarker testing as stipulated by diagnostic guidelines for Cbl deficiency. CONCLUSIONS: This literature does not support an association of Crohn's disease in general, regardless of ileal involvement, with Cbl deficiency. Only ileal resections greater than 20 cm in Crohn's disease predispose to deficiency and warrant treatment. Based on these findings, we suggest a diagnostic and therapeutic algorithm. All findings and recommendations require verification in further studies using confirmatory biomarkers as per diagnostic guidelines for Cbl deficiency. Serum Cbl levels alone are likely insufficient to diagnose deficiency in asymptomatic patients.