Celiac Disease Incidence in Children Varies by Region and Hits 2.5% in Colorado

Celiac.com 01/30/2023 - To spot regional differences in celiac disease autoimmunity and overall celiac incidence for children born between 2004 and 2010, a team of researchers with The Environmental Determinants of Diabetes in the Young (TEDDY) recently set out to follow an HLA-risk selected group of celiac patients using a uniform protocol. The team evaluated children from six different regions within Europe and the United States. 

The research team included Marisa, Stahl MD; Qian, Li PhD; Kristian, Lynch PhD; Sibylle, Koletzko MD, PhD; Pooja, Mehta MD; Loren, Gragert PhD; Jill M, Norris PhD; Carin, Andrén Aronsson PhD; Katri, Lindfors PhD; Kalle, Kurppa MD, PhD; Jorma, Ilonen MD, PhD; Jeffrey, Krischer PhD; Beena, Alkolkar PhD; Annette-G, Ziegler MD; Jorma, Toppari MD, PhD; Marian, Rewers MD, PhD; Daniel, Agardh MD, PhD; William, Hagopian MD, PhD; Edwin, Liu MD;  and the TEDDY Study Group.

Prospective Study of Nearly 7,000 Patients

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The team prospectively enrolled from birth nearly seven thousand patients with DQ2.5 and/or DQ8.1 in Georgia, Washington, Colorado, Finland, Germany, and Sweden. 

They regularly screened the children for tissue transglutaminase antibodies (tTGA), and then assessed them for celiac disease follow-up based on clinical need. 

The team then estimated population-specific figures by weighting the total study-specific incidence with the population-specific haplogenotype frequencies derived from the sites' ample stem cell registries.

Research Findings

Individual haplogenotype risks for celiac disease autoimmunity and celiac disease varied by region. In some regions, the overall numbers of celiac disease are high. 

For example, the team found a celiac incidence of nearly 2.5% by age 10 in Colorado children. Adjusted for HLA, sex, and family history, Colorado children had a 2.5-fold higher risk of celiac disease compared to children in Washington state. Celiac rates by age 10 years were highest for Swedish children, at 3%. 

Their data show that cumulative incidence of celiac disease varies significantly by region, which indicates variable environmental, genetic, and epigenetic factors even within the United States. 

Such high regional case numbers supports the use of low threshold for celiac screening, along with more research into the reasons for the region-specific differences in celiac disease case numbers. 

Read more in the American Journal of Gastroenterology

The researchers in this study are variously affiliated with theDigestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, United States; the Department of Pediatrics, Dr von Hauner Kinderspital, LMU Klinikum, Munich, Germany; the Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland; the Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, United States; the Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Department of Clinical Sciences, Malmo, Lund University, Malmo, Sweden; the Celiac Disease Research Center, Tampere University and Tampere University Hospital; the Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital; the Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States; the Forschergruppe Diabetes e.V. and Institute of Diabetes Research, Helmholtz Zentrum, Munich, Germany; the Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology, Univeristy of Turku, Turku, Finland; the Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Diabetes and Celiac Disease, Lund University, Malmo, Sweden; and the Department of Diabetes, Pacific Northwest Research Institute, Seattle, WA, United States.