A Nationwide Population-based Study

Crohn's Disease and Ulcerative Colitis are Associated With Different Lipid Profile Disorders

Hosim Soh; Jong Pil Im; Kyungdo Han; Seona Park; Seung Wook Hong; Jeong Min Moon; Eun Ae Kang; Jaeyoung Chun; Hyun Jung Lee; Joo Sung Kim


Aliment Pharmacol Ther. 2020;51(4):446-456. 

In This Article

Abstract and Introduction


Background: The relationships between lipid profiles and IBD remain elusive.

Aim: To determine the association of IBD with serum lipid profiles.

Methods: A nationwide population-based study was performed using claims data from the Korean National Healthcare Insurance service. A total of 9 706 026 subjects undergoing medical check-ups in 2009 were enrolled and followed up until 2016. Individuals who developed Crohn's disease (CD) or ulcerative colitis (UC) were identified during follow-up. Adjusted hazard ratio (aHR) by age, sex, body mass index, cigarette smoking, alcohol drinking, exercise, income and underlying comorbidities was calculated to define the impact of serum lipid profiles on developing IBD.

Results: During a median follow-up of 7.3 years, IBD was detected in 7,058 (0.07%) individuals. Compared with the highest quartile of serum total cholesterol (TC) levels, lower TC levels were associated with higher incidence of CD (aHR: Q1, 2.52; Q2, 1.52; Q3, 1.27), but not UC. Lower serum LDL-C levels were associated with higher incidence of CD (aHR: Q1, 1.92; Q2, 1.47; Q3, 1.22), but not UC. Moreover, lower serum HDL-C levels were associated with higher incidence of CD (aHR: Q1, 2.49; Q2, 1.90; Q3, 1.43), but not UC. In contrast, lower serum triglyceride levels were associated with higher incidence of UC (aHR: Q1, 1.22; Q2, 1.19; Q3, 1.19), but not CD.

Conclusions: Low serum TC, LDL-C and HDL-C levels were associated with CD. Low serum triglyceride levels were related to UC.


Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disorder of the intestine, whose pathogenesis involves the interaction between genetic, environmental and immune response factors.[1,2] Western industrialised countries, such as those in North America and Europe, show higher prevalence of IBD compared to other countries, but the ethnic and regional gaps are closing down, indicating the importance of environmental factors.[3–5] Past studies have evaluated the risk factors of IBD, where diet has been extensively studied, indicating that a long term intake of sugars, sweeteners, sweets, and total fats increased the risk of CD and UC,[6–8] also implying that metabolic syndrome, including obesity and dyslipidaemia, may contribute to the incidence of IBD.

Dyslipidaemia refers to elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride and decreased high-density lipoprotein cholesterol (HDL-C), and is well-recognised as a major risk factor for atherosclerosis cardiovascular disease.[9] Cholesterol is a fundamental element for cell membranes, as well as a precursor of various critical steroid hormones, and triglyceride represents the main lipid factor of dietary fat intake. As cholesterol and triglyceride are nonpolar lipid substances, various lipoprotein particles, including LDL-C and HDL-C, are required for transportation.[10] The major atherogenic lipoprotein is LDL-C, which can be reduced by lifestyle modification and cholesterol-lowering drugs, where the lowering would reduce risk for atherosclerosis cardiovascular disease. HDL-C, in contrast, promotes the efflux of excess cholesterol from peripheral tissues to the liver for excretion, and plays a protective function with regard to atherosclerosis.[11] In addition to the relationship between atherosclerosis cardiovascular disease, recent studies have suggested that chronic inflammation may alter the metabolism of lipoproteins, leading to various changes in the individual's lipid profiles. Some studies have reported association between hypocholesterolaemia in patients with IBD, but there have been scarce studies regarding the relationship between lipid profile composition and incidence of IBD. The aim of this nationwide population-based study was to evaluate the association of developing IBD with serum lipid profiles.