Better Cardiorespiratory Endurance Tied to Lower IBD Risk in Kids, Teens

— Other measures of physical fitness not independently associated with IBD risk

MedpageToday
A photo of children running an obstacle course during class.

Better cardiorespiratory endurance was associated with a lower risk of inflammatory bowel disease (IBD) among children and adolescents, a nationwide cohort study from Taiwan showed.

Among nearly 1.4 million 10-year-old students who completed physical fitness tests, better cardiorespiratory endurance was inversely associated with IBD risk (adjusted HR 0.36, 95% CI 0.17-0.75, P=0.007), reported Chun-Ying Wu, MD, PhD, MPH, of National Yang Ming Chiao Tung University in Taipei, and colleagues.

Musculoskeletal endurance, musculoskeletal power, and flexibility fitness were not independently associated with IBD risk, they noted in JAMA Pediatrics.

"The incidence of pediatric-onset IBD has increased worldwide in the past 2 decades and has become a global disease burden in both high-income and low- to middle-income countries," Wu and colleagues wrote.

"Many factors, such as urbanization, air pollution, obesity, appendectomy, prior history of gastroenteritis, prior antibiotic use, and physical fitness, may contribute to gut microbiome alterations in individuals with pediatric-onset IBD," they added. "Previous research has shown that high physical activity is associated with a lower risk of IBD. However, studies to explore the relationship between physical fitness and IBD are limited."

The 6-year cumulative incidence of IBD risk was lowest among students in the best-performing quantile of cardiorespiratory endurance (0.74%, 95% CI 0.63-0.86, P<0.001), musculoskeletal endurance (0.77%, 95% CI 0.65-0.90, P<0.001), and musculoskeletal power (0.81%, 95% CI 0.68-0.93, P=0.005) compared with students in quantiles 2 through 4, respectively. However, there was no association observed for quantiles of flexibility fitness.

Better cardiorespiratory endurance was also associated with lower IBD risk in the 2-year latency period (adjusted HR 0.33, 95% CI 0.12-0.87, P=0.03), but not in the 3-year latency period (adjusted HR 0.30, 95% CI 0.08-1.11, P=0.07).

"In conclusion, we observed that better CE [cardiorespiratory endurance] performance was associated with a reduced risk of developing IBD among children and adolescents in this cohort study," Wu and team wrote. "With the rapid increase of IBD in newly industrialized countries and globally, our study provides interesting evidence to the medical community and public health agencies. Future studies to explore the mechanisms are needed."

The study was conducted from January 2010 through December 2018, using data from the Taiwan National Health Insurance Research Database, the National Student Fitness Tests Database, and the Air Quality Monitoring System Database.

Of the 1,393,641 study participants, mean age was 10.5 years, and 52.1% were boys. The mean duration of follow-up was 4.0 years.

Physical fitness tests included number of minutes to complete an 800-m run for cardiorespiratory endurance, number of bent-leg curl-ups in 1 minute for musculoskeletal endurance, standing broad jump distance for musculoskeletal power, and 2-leg sit-and-reach distance for flexibility fitness.

Participants had mean test scores of 5.0 minutes for cardiorespiratory endurance, 2.7 curl-ups for musculoskeletal endurance, 1.4 m for musculoskeletal power, and 2.8 cm for flexibility fitness.

For their analysis, Wu and colleagues included covariates that may be associated with IBD occurrence, such as age, sex, body mass index, air pollution exposure as determined by the Air Quality Index, urbanization level, comorbidities, and prior antibiotic use.

"Compared with students with poorer CE, students with better CE had a substantially lower risk of IBD in most subgroups, although some results were not statistically significant," they wrote. But musculoskeletal endurance, musculoskeletal power, and flexibility fitness "were not associated with IBD risk in most of the stratified multivariable analyses."

The authors noted that inferring causation between physical fitness and IBD risk based on an observational study is challenging. Other study limitations included the fact that they did not conduct multiple comparison adjustments due to the very low incidence of IBD.

Furthermore, the study's air quality measure might not have captured the small-scale spatial variation of air pollution exposure in each school, and the sensitivity analysis of the latency period confirmed the association in the 2-year period, but not in the 3-year period.

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    Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

Disclosures

This study was supported in part by a grant from the Taiwan Ministry of Health and Welfare, as well as a grant from the National Science and Technology Council.

Wu reported receiving grants from the Ministry of Health and Welfare and the National Science and Technology Council. Co-authors reported receiving grants from the Taiwan Ministry of Education and the Sports Administration and Taiwan Ministry of Education.

Primary Source

JAMA Pediatrics

Source Reference: Wu C-Y, et al "Physical fitness and inflammatory bowel disease risk among children and adolescents in Taiwan" JAMA Pediatr 2023; DOI: 10.1001/jamapediatrics.2023.0929.