General and specific risk markers & preventive factors for chronic fatigue and irritable bowel syndromes

Lead Research Organisation: Queen Mary, University of London
Department Name: Wolfson Institute

Abstract

This research is examining the causes of chronic fatigue/ME and irritable bowel syndrome in the 1958 British Birth cohort, using data on health, family, education, and occupation gathered in childhood and adulthood before the illness develops. An understanding of the causes of these illnesses will contribute to preventing illness, as well as provide useful information for doctors, care providers, and patients and their families. Chronic fatigue syndrome, also known as ME is a debilitating illness, where the sufferer experiences long-term mental and physical tiredness that seriously affects daily life and activities. Little is known about what causes the illness. Few studies have information about the individual’s life before the illness develops and those that do suggest differing evidence for exercise, childhood illness and childhood depression as causes of chronic fatigue. Studies have also not yet examined whether the causes of chronic fatigue are different to the causes of other similar disorders, such as irritable bowel syndrome. This project is examining factors from childhood and adulthood that are thought to cause the development of chronic fatigue and which may also cause irritable bowel syndrome including childhood and adulthood depression, exercise habits, serious illnesses, neglect, and poor parenting in childhood.

Technical Summary

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating illness characterised by prolonged fatigue lasting over 6 months, accompanied by a wide range of symptoms. CFS/ME typically develops in early to mid adulthood, but little is known about the aetiology of the illness, making prevention and treatment challenging.

Previous studies of preventive and risk markers for CFS/ME are predominantly case control studies limited by small samples, lacking prospective data. These studies suggest that psychological health, childhood adversity and physical inactivity are risk markers for CFS/ME. Prospective studies of preventive and risk markers are few and the findings disparate. Analyses of the 1970 birth cohort found that high levels of exercise in childhood decreased risk and childhood illness increased risk of CFS/ME at age 30; in contrast, similar analyses of the 1946 birth cohort found that high levels of exercise in childhood increased risk and childhood illness showed no associated with CFS/ME at age 53. These findings may reflect differential associations for diagnoses in early versus mid-adulthood but further replication is required to inform prevention strategies.

Prospective studies have yet to examine whether preventive and risk markers are specific for CFS/ME or whether they reflect general markers for functional disorders such as CFS/ME and irritable bowel syndrome (IBS). This two year project will utilize the prospective 1958 British Birth cohort data to develop hypothesis testing models of lifecourse preventive and risk markers of CFS/ME and IBS, examining general and specific markers for CFS/ME and IBS, as well as replicating previous analyses of the 1970 and 1946 cohorts in relation to CFS/ME.

The 1958 Cohort is a prospective study of over 17,000 births, followed up over a 45 year period. This project will focus on health outcomes at 42y (N=11419), and preventive and risk markers from childhood (7y, 11y, 16y) and adulthood (23y, 33y). Hypotheses testing preventive and risk factors relating to psychological health across the lifecourse, childhood adversity, physical inactivity, body mass index, and chronic childhood illness will be tested. Age of onset for CFS/ME and IBS is known enabling pre-morbid factors to be distinguished from post-morbid factors.

This project offers a unique opportunity to test many of the prevailing hypotheses relating to preventive and risk markers of CFS/ME and IBS in a large prospective dataset. Information about markers and the specificity of markers for CFS/ME and IBS will be a useful addition to knowledge for practitioners, care providers and patients.

Publications

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Title Data derived 
Description New outcomes and predictor variables relevant for chronic fatigue have been developed for the 1958 Birth cohort data concerning fatigue symptoms, IBS, childhood illnesses, physical activity. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2009 
Provided To Others? Yes  
Impact The variables derived will be of use to the 1958 cohort research community, not just those interested in chronic fatigue. 
 
Title Multivariate risk factor models for chronic fatigue and IBS 
Description This study is one of the first to develop multivariate risk factor models for chronic fatigue and IBS - most previous studies do not look at a wide range of factors across the lifecourse 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact Hopefully, three peer-reviewed papers as this work is ongoing - project not completed yet which makes this e-val slightly premature 
 
Description UCL Whitehall II study 
Organisation University College London
Department Institute of Epidemiology and Health Care
Country United Kingdom 
Sector Academic/University 
PI Contribution LG - the postgraduate on this project, has taken the lead with the collaboration in terms of undertaking the analyses. I had previously worked with some of the UCL team, and introduced LG to them. I will further be involved in assisting LG to write up the paper
Collaborator Contribution This is an ongoing collaboration, comparing analyses in the 1958 cohort which arose from our MRC funding, with analyses currently being conducted by one of our team using the Whitehall II data. One publication should result from this collaboration initially.
Impact Analyses are ongoing
Start Year 2010
 
Description AEP Epidemiology and Social Psychiatry Congress, Bergen 2011 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Participants in your research and patient groups
Results and Impact Gave presentation of research findings during a session on somatic illnesses during the conference. Followed by discussion

Interesting discussions arose with some Norwegian colleagues doing work on somatic non-specific symptoms. We were able to offer statistical advice. Later suggested someone from this team to review one of our journal papers.
Year(s) Of Engagement Activity 2010
 
Description Action for CFS - Milton Keynes 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact Poster and oral conference presentation to health professionals and patient groups

Won best poster prize at this meeting
Year(s) Of Engagement Activity 2009
 
Description American Psychosomatic Society Conference 2011 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Health professionals
Results and Impact Presented two poster presentations - one summarising the Irritable Bowel Syndrome findings and the other the Chronic Fatigue Syndrome findings for this project. Made oral presentation and discussion and questions afterwards

Met with other UK researchers in the field, as well as international researchers. This has helped with suggesting reviewers for the papers we have currently submitted for this grant
Year(s) Of Engagement Activity 2010
 
Description Chronic Fatigue Clinicians 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Health professionals
Results and Impact Discussion of initial project findings with clinical 'chronic fatigue' team within the hospital. 1 hour duration.

Feedback from health professionals about our research
Year(s) Of Engagement Activity 2008
 
Description World Congress in Psychosomatic Medicine 2010 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Health professionals
Results and Impact Gave an oral presentation, followed by discussion and questions

Gained input from health professionals and academics in the field, which informed writing journal paper of this work.
Year(s) Of Engagement Activity 2010