Celiac.com 04/07/2008 - No, this is not some kind of April Fool’s joke. When I read this report, I just about fell off my chair. New research indicates that being poor and living in squalor might actually provide some benefit against the development of celiac disease.

A team of medical researchers recently set out to examine gene-environmental interactions in the pathogenesis of celiac disease. The research team was made up of A. Kondrashova, K. Mustalahti, K. Kaukinen, H. Viskari, V. Volodicheva, A. M. Haapala, J. Ilonen, M. Knip, M. Mäki, H. Hyöty, T. E. Group. Finland and nearby Russian Karelia have populations that eat about the same amounts of the same grains and grain products. The two populations also have a high degree of shared genetic ancestry. The only major difference between the populations of the two areas lies in their socioeconomic conditions.

The region of Russian Karelia is much poorer than the neighboring areas in nearby Finland. The sanitation levels in Russian Karelia are also distinctly inferior than they are in Finland. The researchers compared the prevalence of celiac disease and predisposing human leukocyte antigen (HLA) alleles in populations from Russian Karelia and Finland. The team performed screening for tissue transglutaminase antibodies (tTG) and HLA-DQ alleles on 1988 school-age children from Karelia and 3654 children from Finland. Children with transglutaminase antibodies were encouraged to have a duodenal biopsy.

Interestingly, the patients from Russian Karelia showed tTG antibodies far less often than their Finnish counterparts (0.6% compared to 1.4%, P = 0.005). The patients from Russian Karelia also showed Immunoglobulin class G (IgG) antigliadin antibodies far less frequently than their Finnish patients (10.2% compared to 28.3%, P<0.0001).

The researchers confirmed a diagnosis of celiac disease by duodenal biopsy in four of the eight transglutaminase antibody-positive Karelian children, for an occurrence rate of 1 in 496 versus 1 in 107 Finnish children.

In both groups, the same HLA-DQ alleles were associated with celiac disease and the presence of transglutaminase antibodies. The patients from Russian Karelia showed a much lower prevalence of transglutaminase antibodies and celiac disease than the Finnish children. 

The poor conditions and inferior hygienic conditions in Russian Karelia might provide some kind of protection against the development of celiac disease. The value of studies like this aren’t to make us wax nostalgic for poverty, or to encourage people to fend off celiac disease by becoming poor and living in squalid conditions. The value of a study like this lies in the idea that there may be more to the development of celiac disease than simple biological factors. That environmental conditions might play a key role in both the frequency of celiac-related antibodies, and in the development of the disease itself is quite intriguing and clearly warrants further and more comprehensive study.

Ann Med. 2008;40(3):223-31.

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