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    Study Clarifies Risk Levels for Development of Celiac Disease in Children with Type-1 Diabetes


    Jefferson Adams


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    Celiac.com 07/10/2007 - Studies have shown children with Type 1 diabetes to have a greater risk of developing celiac disease. A study published recently in Diabetes Care shows that people with celiac disease who follow a strict gluten-free diet frequently have inferior body composition and nutritional uptake compared to healthy people without celiac disease.

    Faced with a shortage of solid data on the exact nature of the levels at which children with type 1 diabetes are at risk for developing celiac disease, a Swedish research team set out to review the Swedish national inpatient registry for the years 1964 to 2003. The research team was made up of Anders Ekbom, Michael Fored, Jonas F. Ludvigsson, Johnny Ludvigsson, Nders Ekbom, Ola Ole, & Scott M. Montgomery. They looked at data for patients with celiac disease who are following a strict gluten-free diet, and who were in full clinical, biochemical, and histological remission. They looked at data from 45,680 patients. Children with a one year follow-up after entering the study were added to the final results.

    Celiac Disease in Children Linked to Type-1 Diabetes

    The results showed that children with celiac disease face an increased risk of developing type 1 diabetes before the age of 20 (hazard ratio 2.4 [95% CI 1.9 –3.0], P 0.001). Children with celiac disease also faced an increased risk of ketaocidosis or diabetic coma before the age of 20 (2.3 [1.4 –3.9], P 0.001).

    This increase showed up without regard to the age at diagnosis [those diagnosed between 0 and 2 (2.2 [1.7–2.9], P 0.001) or 3 and 20 (3.4 [1.9 – 6.1], P 0.001) years of age.]

    Given that 95% of individuals with celiac disease are HLA-DQ2 positive, these increased risk levels were comparatively low, though still significant.

    Diabetes Care. 2006 Nov;29(11):2483-8.

    health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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    Scott Adams
    Diabetes Care 2004;27:1294-1298.
    Celiac.com 11/29/2004 - In an effort to determine the prevalence of biopsy-confirmed celiac disease in Italian children and adolescents with type 1 diabetes, and to determine whether age at onset of diabetes is independently associated with the diagnosis of celiac disease, Dr. Franco Cerutti and colleagues at the Universita di Torino, Italy looked at 4,322 children and adolescents (4-11 years old) who had type 1 diabetes. Yearly celiac disease screening was performed on them by using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies, and those with positive antibody results were given a biopsy for confirmation. Out of 4,322 children screened 292 or 6.8% had celiac disease. In 89% of cases diabetes was diagnosed before celiac disease. Using logistic regression analyses the researchers determined that those diagnosed with diabetes at a younger age, those who are female, and those with a thyroid disorder are independently associated with the risk of having both diabetes and celiac disease.
    The researchers conclude: "We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age 9 years; and 3) girls have a higher risk of having both diseases than boys."

    Scott Adams
    Arch Dis Child 2004;89:871-876. Celiac.com 07/12/2005 – Australian researchers have determined that a gluten-free diet in children with Type 1 diabetes mellitus and celiac disease can improve both growth and diabetes control. In the study 21 children (mean age 7.5 years) with both conditions went on a gluten-free diet for 12 months, and their growth and insulin dosages were carefully measured and compared with that of two matched diabetic, non-celiac controls. The group on a gluten-free diet showed significant increases in weight and body mass index compared with the control group, although an increase in height found in the study was not found to be significant. At the time of diagnosis insulin dosages for the celiac disease group were less than that of the control group, but became similar to the controls once a gluten-free diet was started—although the increase in insulin dosage had no effect on HbA1c levels.
    The researchers conclude: “Identification and dietary treatment of celiac disease in children with diabetes improved growth and influenced diabetic control. Evaluation of the outcome of treatment of celiac disease in diabetics should include assessments of gluten intake.” Obviously all children (and everyone) with celiac disease should be on a gluten-free diet, but what is noteworthy about this study is that a connection was found between insulin levels, diabetes control, and the gluten-free diet.

    Scott Adams
    Celiac.com 11/07/2006 – In the first multi-country population based study of its kind, Danish researchers have found that around 1 in 8 children with Type 1 diabetes also have celiac disease, and of these the prevalence of stunted growth is abnormally high. Dr. Dorte Hansen and colleages from Odense University Hospital screened 269 children with type 1 diabetes for celiac disease using immunoglobulin A anti-endomysium antibody, anti-tissue transglutaminase antibody, and intestinal biopsy. The researchers found 33 cases of celiac disease, and in 5 of these cases the children had no symptoms of the disease whatsoever. The children with celiac disease were diagnosed with diabetes at a significantly youger age than their non-celiac counterparts and each was also significantly shorter and lighter.
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    Diabetes Care 2006;29:2452-2456.

    Jefferson Adams
    Celiac.com 06/08/2007 - This study shows that celiac disease is as common among British Columbians with Type 1 diabetes as it is in Europeans with Type 1 Diabetes.
    The research team was made up of doctors P.M. Gillett, H.R. Gillett, D.M. Israel, D.L. Metzger, L. Stewart, J-P. Chanoine, H.J. Freeman.
    The team looked at 233 children with Type1 diabetes. In a blind study, the children were screened for celiac disease using immunoglublin A endomysium antibody (EmA), and the Immunoglublin A tissue transglutaminase. Children with positive results were offered small bowel biopsies. For those confirmed with celiac disease, doctors recommended a gluten-free diet.
    British Columbians with Type 1 Diabetes Get Celiac Disease at Rates Comparable to their European Counterparts
    Nineteen children tested positive for EmA and showed elevated tTG levels. Of the 18 patients who agreed to biopsies, one was normal, three showed normal morphology with elevated Intraepithelial lymphocyte counts, and 14 biopsies showed morphological changes consistent with celiac disease.
    9 of the 19 children who tested positive for EmA were asymptomatic. Seven patients showed only mildly elevated tTG levels. Of this second group, five refused biopsy and two showed normal biopsies.
    In addition to the four known cases, the doctors uncovered at least 14 new cases of celiac disease. The total rate of biopsy confirmed celiac disease was 18 out of 233, or 7.7%. The doctors concluded that these results confirm that celiac disease is prevalent in pediatric type 1 diabetes.
    The doctors say the study reinforces the importance of celiac screening for children with type 1 diabetes, and also the advisability of keeping an eye on tTg serology as part of determining the effects of and compliance to a gluten-free diet.
    Participating Facilities
    1. Division of Pediatric Gastroenterology at British Columbias Childrens Hospital Vancouver, British Columbia.
    2. Division of Endocrinology, British Columbias Childrens Hospital, Vancouver, British Columbia.
    3. Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia
    Journal of Pediatric Gastroenterology & Nutrition: Volume 29(4)October 1999p 495.
    About the Author: Jefferson Adams is a freelance health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

  • Recent Articles

    Jefferson Adams
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    Dr. Ron Hoggan, Ed.D.
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    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
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    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
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    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
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    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.