Risk factors for inflammatory bowel diseases according to the "hygiene hypothesis": a case-control, multi-centre, prospective study in Southern Italy

J Crohns Colitis. 2012 Apr;6(3):324-9. doi: 10.1016/j.crohns.2011.09.003. Epub 2011 Oct 7.


Background: Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBD) of unknown aetiology. The 'hygiene hypothesis' (HH) suggests that several hygiene-related factors may have contributed to the increased incidence of IBD. The aim of the study was to evaluate risk factors for IBD related to HH in a cohort of IBD patients from the south of Italy.

Methods: We prospectively performed a one-year, questionnaire-based, case-control, multi-centre study focusing on the principal risk factors for IBD according to HH. We investigated the main surrogate markers of HH (helmintic infections and antibiotics in childhood; breastfeeding; family size/sibship;urban upbringing; personal and domestic hygiene in childhood) in UC and CD patients, in comparison with a control group of healthy subjects. In addition, the traditional risk factors for IBD were also recorded.

Results: The study population included 527 cases of UC, 468 CD and 562 controls. None of the surrogate risk factors of HH was significantly associated with IBD. On the contrary, the traditional risk factors confirmed their statistical significance in this IBD population. Familial aggregation: OR 4.07 for UC; OR 4.83 for CD; smoking: OR 0.38 for UC; OR 1.40 for CD; appendectomy: OR 0.28 for UC; OR 1.61 for CD.

Conclusion: Even though risk factors associated to the HH have been proposed as a possible explanation for the increasing calendar trend of IBD incidence, their role does not appear to be statistically significant. Familial aggregation, smoking habits and appendectomy still remain the main risk factors associated with IBD.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Appendectomy / adverse effects
  • Breast Feeding
  • Case-Control Studies
  • Chi-Square Distribution
  • Child
  • Colitis, Ulcerative / epidemiology*
  • Colitis, Ulcerative / genetics
  • Crohn Disease / epidemiology*
  • Crohn Disease / genetics
  • Family Characteristics
  • Female
  • Helminthiasis / epidemiology
  • Humans
  • Hygiene
  • Hygiene Hypothesis*
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Smoking / adverse effects
  • Surveys and Questionnaires
  • Urban Population
  • Young Adult


  • Anti-Bacterial Agents