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Prevalence of celiac disease: before and after a national change in feeding recommendations
Annelie Carlsson1, Daniel Agardh, Stefan Borulf
1Department of Pediatrics, Lund University Hospital, Lund, Sweden. Annelie.Carlsson@skane.se
Insights
Sweden's 1996 infant feeding change, recommending earlier gluten introduction, did not alter undiagnosed celiac disease rates. However, symptomatic celiac disease prevalence decreased in children born after the recommendation.
Area of Science:
- Pediatrics
- Gastroenterology
- Immunology
Background:
- Sweden revised infant feeding guidelines in 1996, suggesting earlier gluten introduction (4 months vs. 6 months).
- This change aimed to potentially influence the development of celiac disease in infants.
Purpose of the Study:
- To compare the prevalence of celiac disease in children born before and after the 1996 infant feeding recommendations.
- To assess the impact of altered gluten introduction timing on celiac disease incidence.
Main Methods:
- Serological screening for IgA-antigliadin antibodies (AGA) and IgA-endomysial autoantibodies (EMA) in children.
- Comparison of antibody levels and confirmed celiac disease diagnoses between cohorts born before (1992-1993) and after (1996-1997) the guideline change.
- Intestinal biopsy for definitive diagnosis in positive cases.
Main Results:
- No significant difference in the overall prevalence of undiagnosed celiac disease was found between the two cohorts (0.7% vs. 1.3%).
- A statistically significant decrease in symptomatic celiac disease was observed in the cohort born after the 1996 recommendations (0.3% vs. 0.7%).
Conclusions:
- The updated infant feeding recommendations in Sweden were associated with a reduction in symptomatic celiac disease.
- The study did not find evidence that the earlier introduction of gluten influenced the overall prevalence of undiagnosed celiac disease.
Objective:
A national change in infant feeding recommendations was proposed in 1996 in Sweden: a slow introduction to gluten during weaning was stressed, the recommendation being introduction at 4 instead of 6 months of age. The aim of the present study was to compare the prevalence of celiac disease in healthy young children born before and after the new feeding recommendations in 1996.
Material And Methods:
Sera from 679 children at a median age of 2.9 years (range 2.5-4.2 years) born between January 1996 and November 1997 were investigated with IgA-antigliadin antibodies (AGA) and IgA-endomysial autoantibodies (EMA) and compared with 690 age-matched children born between July 1992 and June 1993. Children with a positive test for EMA and AGA or EMA only were re-tested, and if positive at follow up, investigated with intestinal biopsy.
Results:
At baseline, 2.2% (15/679) children were positive for EMA and another 0.6% (4/679) for both EMA and AGA. One child refused to be re-tested and eight children were still EMA positive at follow-up. Intestinal biopsy was performed in seven children (one declined biopsy), of whom three showed total villous atrophy. Two children with EMA titers 1:640, respectively, refused further participation in the study, but were strongly suspected to have celiac disease. In total, 0.7% (5/679) (95% confidence interval (CI) = 0.1-1.4%) were considered to have celiac disease compared with 1.3% (9/690) (95% CI = 0.4-2.2%) in the control group (p=0.4217). In addition, 0.3% of the children were diagnosed with symptomatic celiac disease compared with 0.7% in controls (p=0.0134).
Conclusions:
The prevalence of symptomatic celiac disease declined after the infant dietary recommendations were introduced in 1996, but we could not find any difference in undiagnosed celiac disease between the screened children born before and those born after 1996.
