Celiac disease risk varies between birth cohorts, generating hypotheses about causality: evidence from 36 years of population-based follow-up

Abstract

BackgroundCeliac disease (CD) is a major public health problem with estimated 1-3% prevalence in the general population. In recent years an increase in CD prevalence has been reported both in Sweden and worldwide. This study aimed at examining the annual incidence rate of biopsy-proven celiac disease among children in Sweden over a 36-year period, to assess variations by age, sex and birth cohort, and to assess the clinical impact of these changes.MethodsThe National Swedish Childhood CD Register was used to identify 9107 children aged 0–14.9 years who were diagnosed with CD during the period 1973 to 2009. From 1973 to 1990 the register covered 15% of the nation, this increased to 40% during 1991–1997; a full national coverage was obtained from 1998 onwards. Estimations for the annual incidence rate, cumulative incidence and clinical impact by age groups, calendar month and birth cohorts were made.ResultsCD incidence is continuing to increase in the child population aged 2–14.9 years. A continued variation in CD incidence was observed in children aged 0–1.9 years, characterized by a marked decrease in most recent years. The median age at diagnosis has increased from 1.0 year in the 1970s to 6.8 years in 2009. The average number of new cases has risen from ~200 during 1973–1983 to ~600 during 2004–2009. In the birth cohorts of 2000–2002 the cumulative incidence even exceeded that of the epidemic cohorts at comparable ages. The highest cumulative incidence was observed in the birth cohorts of 1985–1995 and 2000–2002.ConclusionsCD risk varies between birth cohorts, suggesting cyclic environmental and/or lifestyle risk factors in CD etiology. More research on underlying risk factors is required in order to move forward with preventive strategies.

Special diets are common among preschool children aged one to five years in south‐east Sweden according to a population‐based cross‐sectional survey

“…The prevalence of gluten avoidance among preschool children in south-east Sweden was similar to the prevalence of coeliac disease in screening studies (13,14). The fact that the disease is more common in females is reflected in our results (13).…”

“…The fact that the disease is more common in females is reflected in our results (13). According to the National Swedish Childhood Celiac Disease Register in March 2016, only eight children aged 1-5 living in the municipality had a registered diagnosis of coeliac disease (14). This indicates that eight of the 16 children in our study who avoided gluten might have undiagnosed coeliac disease or they avoid gluten unnecessarily.…”

“…Adulttype lactose intolerance is thought to be uncommon in Sweden, at 2-3%, and symptoms do not typically develop before the age of four to five years (11,12). Coeliac disease is underdiagnosed, and the overall prevalence in Western populations is close to 1% and even higher in northern Europe (13)(14)(15).…”

Demographics, clinical features and treatment of pediatric celiac disease

“…This result coincides with data reported from other countries but also from Sweden, suggesting similar increase (Mc Gowan 2009, Savilahti 2010, Tanpowpong 2012, Namatovu 2014. It is worth mentioning that the increase of mean age at diagnosis for the neighboring Finnish children preceded the Swedish dito observed after the epidemic period (Ascher 1993).…”

“…In 1996 the Swedish Pediatric Association revised the infant feeding recommendations once more, suggesting that gluten should be introduced in small amounts from 4 months of age and preferably along with on-going breast-feeding. During the epidemic period, the incidence rate of CD children detected clinically under the age of 2 years increased four-fold in comparison to the time period before (pre-epidemic period) and after (post-epidemic period) (Namatovu 2014). A plethora of studies indicates that the incidence rate of pediatric CD increased during the latest years, varying though worldwide a, Whyte 2013, Zingone 2015.…”