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Incidence of Pediatric Celiac Disease Varies by Region
Marisa Stahl1, Qian Li2, Kristian Lynch3
1Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Insights
Regional differences significantly impact celiac disease (CD) development. Swedish children show the highest CD incidence by age 10, highlighting the need for region-specific research into environmental triggers.
Area of Science:
- Pediatric immunology
- Gastroenterology
- Environmental epidemiology
Background:
- Celiac disease (CD) is an autoimmune disorder influenced by genetic and environmental factors.
- The Environmental Determinants of Diabetes in the Young (ENDIU) study investigates CD development in a birth cohort with HLA risk.
- Understanding regional variations in CD incidence is crucial for public health strategies.
Purpose of the Study:
- To identify regional differences in celiac disease (CD) autoimmunity and cumulative incidence.
- To compare CD development among children born between 2004 and 2010 across diverse geographic locations.
- To analyze the impact of HLA risk factors on CD incidence in different regions.
Main Methods:
- Prospective enrollment of 6,628 children with specific HLA types (DQ2.5 and/or DQ8.1) from birth.
- Periodic screening for tissue transglutaminase antibodies and clinical CD evaluation.
- Calculation of population-specific estimates using weighted cumulative incidence and haplogenotype frequencies.
Main Results:
- Significant regional variations in CD autoimmunity and cumulative incidence were observed.
- The highest CD incidence by age 10 was in Swedish children (3%), followed by Colorado (2.4%).
- Colorado children had a 2.5-fold higher CD risk compared to Washington; Swedish children had higher risks than Finnish and German children.
Conclusions:
- High regional variability in CD incidence suggests differential environmental, genetic, and epigenetic influences.
- The study underscores the need for a low threshold for CD screening due to high overall incidence.
- Further research into region-specific CD triggers is warranted to inform prevention and management strategies.
Introduction:
The Environmental Determinants of Diabetes in the Young study follows an HLA risk selected birth cohort for celiac disease (CD) development using a uniform protocol. Children under investigation come from 6 different regions within Europe and the United States. Our aim was to identify regional differences in CD autoimmunity and CD cumulative incidence for children born between 2004 and 2010.
Methods:
Children (n = 6,628) with DQ2.5 and/or DQ8.1 were enrolled prospectively from birth in Georgia, Washington, Colorado, Finland, Germany, and Sweden. Children underwent periodic study screening for tissue transglutaminase antibodies and then CD evaluation per clinical care. Population-specific estimates were calculated by weighting the study-specific cumulative incidence with the population-specific haplogenotype frequencies obtained from large stem cell registries from each site.
Results:
Individual haplogenotype risks for CD autoimmunity and CD varied by region and affected the cumulative incidence within that region. The CD incidence by age 10 years was highest in Swedish children at 3%. Within the United States, the incidence by age 10 years in Colorado was 2.4%. In the model adjusted for HLA, sex, and family history, Colorado children had a 2.5-fold higher risk of CD compared to Washington. Likewise, Swedish children had a 1.4-fold and 1.8-fold higher risk of CD compared with those in Finland and Germany, respectively.
Discussion:
There is high regional variability in cumulative incidence of CD, which suggests differential environmental, genetic, and epigenetic influences even within the United States. The overall high incidence warrants a low threshold for screening and further research on region-specific CD triggers.
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