Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 528-534 (doi:10.1542/10.1542/peds.2007-2989)
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ARTICLE

Difference in Celiac Disease Risk Between Swedish Birth Cohorts Suggests an Opportunity for Primary Prevention

Cecilia Olsson, RDa,b, Olle Hernell, PhDc, Agneta Hörnell, PhDa, Göran Lönnberg, BScb and Anneli Ivarsson, PhD, MDb

a Department of Food and Nutrition, Faculty of Social Sciences
b Department of Public Health and Clinical Medicine, Division of Epidemiology and Public Health Sciences
c Department of Clinical Sciences, Division of Pediatrics, Faculty of Medicine, Umeå University, Umeå, Sweden

OBJECTIVES. Sweden experienced a unique epidemic of celiac disease in children <2 years of age. The epidemic was partly explained by changes in infant feeding over time and indicated a multifactorial pathogenesis. The main aim of this study was to analyze celiac disease risk in epidemic and postepidemic birth cohorts up to preschool age, to explore further the opportunity for primary prevention.

METHODS. A population-based incidence register of celiac disease in children covering the entire nation from 1998 to 2003 and part of the country back to 1973 was analyzed. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for celiac disease were used. The annual incidence rate for each age group and the cumulative incidence according to age for each birth cohort were calculated.

RESULTS. A considerable difference in cumulative incidences of celiac disease at comparable ages was demonstrated between birth cohorts from the epidemic and postepidemic periods. The difference persisted during the preschool years, although it decreased somewhat with age. During the last years of the follow-up period, there was again a successive increase in incidence rate among children <2 years of age.

CONCLUSIONS. The difference in celiac disease risk between birth cohorts at comparable ages suggests an opportunity for primary prevention. This highlights the importance of further exploring the role of infant feeding and exogenous factors besides dietary gluten that might initiate or prevent disease development. Moreover, on the basis of postepidemic incidence trends, we speculate that the Swedish epidemic might not have been as unique as thought previously, although its magnitude was striking.

Key Words: celiac disease • children • incidence • infant nutrition • prevention

Abbreviations: CD—celiac disease • CI—confidence interval • ESPGHAN—European Society for Pediatric Gastroenterology, Hepatology, and Nutrition • IEL—intraepithelial lymphocyte • RR—rate ratio

Accepted Dec 19, 2007.


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Arch. Dis. Child., December 1, 2008; 93(12): i - i.
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