Autoimmune hepatitis: the role of environmental risk factors: a population-based study
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The etiology of autoimmune hepatitis (AIH) likely involves a complex interaction of genetic and environmental factors. We aim to investigate the associations between exposure to putative environmental factors and AIH and to quantify AIH risk in a first-degree relative.
We conducted a population-based case-control study. Cases were AIH patients who were alive and resided in Canterbury, New Zealand, between 1 July 2011 and 30 June 2012. Controls were randomly selected from the Electoral Roll and were matched 2:1 to each case by age and gender. Self-reporting questionnaires that cover lifestyle factors, childhood factors and family history were used.
72 AIH cases and 144 controls were included. We found that exposure to antibiotics within 12 months prior to AIH diagnosis (OR 12.98, 95 % CI 2.49–67.67, p < 0.01) was an independent risk factor for the development of AIH. Alcohol consumption (OR 0.43, 95 % CI 0.28–0.68, p < 0.01) and childhood home with wood heating (OR 0.30, 95 % CI 0.14–0.63, p < 0.01) were independently associated with reduced risks of later development of AIH. The crude risk of AIH in first-degree relatives of a patient with AIH was 0.2 % (95 % CI <0.1–2.0).
We found that antibiotics are an independent risk factor for the development of AIH, whereas alcohol consumption and living in a childhood home with wood heating are independent protective factors against the later development of AIH.
KeywordsAutoimmune hepatitis Environmental Risk factors Pathogenesis
Human leukocyte antigen
Inflammatory bowel disease
New Zealand socio-economic index 1996
Systemic lupus erythematous
Major histocompatibility complex
Financial support for this study was provided by the Royal Australasia College of Physicians, New Zealand. Dr. Ngu is the recipient of a Clinical Fellowship from the Health Research Council of New Zealand.
Conflict of interest
Jing H. Ngu, Richard B. Gearry, Chris M. Frampton, and Catherine A.M. Stedman declare that they have no conflict of interest.
Compliance with Ethical Requirements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Upper South A Regional Ethics Committee of New Zealand, approval no. URA/10/07/055) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.
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