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Children born in the summer have increased risk for coeliac disease
A Ivarsson1, O Hernell, L Nyström
1Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden. Anneli.Ivarsson@epiph.umu.se
Insights
Children born in summer have a higher risk of coeliac disease (permanent gluten sensitive enteropathy). This seasonal risk pattern suggests environmental factors, potentially infections, play a role in coeliac disease development.
Area of Science:
- Pediatric Gastroenterology
- Environmental Epidemiology
- Immunology
Background:
- Coeliac disease (permanent gluten sensitive enteropathy) is a growing public health concern.
- Identifying environmental triggers is crucial for primary prevention strategies.
- Seasonal variations in birth may indicate underlying environmental exposures influencing disease aetiology.
Purpose of the Study:
- To investigate the association between month of birth and the risk of developing coeliac disease.
- To explore potential seasonal patterns in environmental factors contributing to coeliac disease.
- To assess if birth season is a risk indicator for coeliac disease in children.
Main Methods:
- Population-based incidence register of coeliac disease in children (<15 years) from 1973-1997 in Sweden.
- Incidence rates stratified by month of birth and age at diagnosis.
- Poisson regression used to calculate relative risk (RR) by season of birth, adjusting for gender and diagnosis period.
Main Results:
- Children diagnosed with coeliac disease before age 2 had a significantly higher risk if born in summer versus winter (RR=1.4).
- This seasonal risk pattern persisted during a coeliac disease epidemic, despite varying incidence rates.
- While girls had higher overall incidence, boys exhibited a more pronounced seasonal risk variation.
Conclusions:
- The observed increased risk of coeliac disease in children born in summer suggests a seasonal environmental exposure.
- Infections are a potential key factor, possibly interacting with other exposures like gluten intake.
- Further research should also consider non-infectious environmental factors in coeliac disease aetiology.
Study Objective:
Coeliac disease, also called permanent gluten sensitive enteropathy, is being recognised as a widespread health problem. Defining the possible role of environmental factors in its aetiology might open doors to primary prevention. This study therefore analysed if the risk for coeliac disease varies with month of birth as a proxy for a seasonal pattern for possible causal environmental exposure(s).
Design:
A population based incidence register of coeliac disease in children below 15 years of age covering the period from 1973 to 1997. Incidence rates were calculated by month of birth, stratified for age at diagnosis. Poisson regression analyses were used to estimate the relative risk for coeliac disease for children below 2 years of age by season of birth, also taking into account gender and time period of diagnosis.
Setting:
Sweden.
Participants:
All 2151 children in the study base with verified coeliac disease.
Main Results:
The risk for coeliac disease was significantly higher if born during the summer as compared with the winter (RR=1.4, 95% CI 1.2 to 1.7), but only in children below 2 years of age at diagnosis. This relative seasonal risk pattern prevailed during a 10 year epidemic of coeliac disease, although incidence rates varied threefold. The incidence was constantly higher among girls as compared with boys, but boys showed a more pronounced seasonal variation in risk than girls.
Conclusions:
An increased coeliac disease risk in children born in the summer compared with the winter reflects causal environmental exposure(s) with a seasonal pattern. Infections might be the exposure of importance, either by means of a direct causal role and/or through interaction with other exposures, for example, gluten intake. However, non-infectious exposures should also be explored as possible contributing causal factors.