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Celiac.com 06/20/2022 - Doctors currently recommend that first-degree relatives of those with celiac disease also get screened for the disease, but it's been unclear how often doctors should screen, or at what age. A team of researchers recently set out to detect variables influencing the risk of celiac disease development so they can develop and validate clinical prediction models in order to provide individualized screening advice. The research team included Caroline R. Meijer; Renata Auricchio; Hein Putter; Gemma Castillejo; Paula Crespo; Judit Gyimesi; Corina Hartman; Sanja Kolacek; Sibylle Koletzko; Ilma Korponay-Szabo; Eva Martinez Ojinaga; Isabel Polanco; Carmen Ribes-Koninckx; Raanan Shamir; Hania Szajewska; Riccardo Troncone; Vincenzo Villanacci; Katharina Werkstetter; and M. Luisa Mearin. The team analyzed ten years of follow-up data from the PreventCD-birth cohort, which enrolled nearly a thousand genetically predisposed children with celiac-affected first-degree relatives. The researchers combined significant variables for celiac risk to establish a risk score, and performed landmark analyses at different ages to create prediction models using multivariable Cox proportional hazards regression analyses, backward elimination, and Harrell’s c-index for discrimination. They used data from the independent NeoCel cohort to validate their findings. Their results show that the children with celiac-affected first-degree relatives develop celiac disease early in life, and that the main risk factors are gender, age and HLA-DQ genetic markers, which are all important for sound screening advice. According to the researchers children with celiac-affected first-degree relatives should be screened early in life, which should also include HLA-DQ2/8–typing. Anyone genetically predisposed to celiac disease should get more personalized screening advice using the team's Prediction application. Read more in Gastroenterology
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The Ten Risk Factors Most Associated with Celiac Disease
Jefferson Adams posted an article in Celiac Disease Basics
Celiac.com 08/16/2019 - A recent study looked at nine possible factors in children that might contribute to the development of celiac disease later in life. The study found a connection between skim milk consumption, and vitamin D drop use for more than 3 months, and later development of celiac disease. It also found evidence to support earlier data that early life exposure to antibiotics and early life infection, especially ear infection, are also associated with the development of celiac disease in children. Read more in Clinical and Experimental Gastroenterology This study and several others point to the importance of the following risk factors in the development of celiac disease. Other studies have found factors that may contribute to celiac disease. The Ten Risk Factors Most Associated with Celiac Disease Include: Genetic Factors Genetic factors play a role in celiac disease. Having a family member with celiac disease or dermatitis herpetiformis increases the chances of developing celiac disease. The risk of developing celiac disease is also increased by certain variants of the HLA-DQA1 and HLA-DQB1 genes. These genes provide instructions for making proteins that play a critical role in the immune system. A recent study shows high celiac disease rates among first-degree family relatives. Associated Diseases Having associated autoimmune or other diseases increases the likelihood of developing celiac disease. Associated diseases include: Autoimmune thyroid disease Dermatitis herpetiformis Lupus erythematosus Microscopic colitis (lymphocytic or collagenous colitis) Rheumatoid arthritis Type 1 diabetes Down syndrome or Turner syndrome Addison's disease Being Female Being female is a risk factor for celiac disease? It's true. Women get celiac disease at rates up to twice as high as men. The exact reasons for this are unknown, but many researchers are focused on the role of female immune response, and how it differs from that of men. Antibiotics Courses of antibiotics before 2 years old are associated with higher celiac disease rates. Ear Infection Incidence of ear infection before 2 years old are associated with higher celiac disease rates. The ORs for the raw categorical variables on ear infection increase with the number of such infections. In addition, the scaled ear infection exposure variable is associated with a subsequent diagnosis of celiac disease. Other studies have also shown a connection between ear infections and later celiac disease. Viral Infection Several studies have shown that exposure to certain viruses is associated with higher rates of celiac disease later on. Implicated viruses include enterovirus and reovirus. Vitamin D Drop Exposure in Infancy Some recent evidence points to the role of oral vitamin D exposure in later celiac development. While the OR on only one of the vitamin D drop categorical variables is statistically significant (Table 2), these variables do suggest a pattern. Specifically, the data suggests that infants who receive oral vitamin D drops for longer than 3 months are at increased risk of subsequently developing celiac disease. Skim Milk Recent data suggests that consumption of skim milk as the primary form of liquid cow’s milk between 2-3 years old is associated with a subsequent diagnosis of celiac disease. In general, kids who drank skim or low-fat milk had more celiac disease, and more diarrhea. Age at First Gluten Consumption A 2015 study by Carin Andren Aronsson, from the department of clinical sciences at Lund University in Sweden, and colleagues, shows that children who eat more foods with gluten before they're 2 years old have a greater risk of developing celiac disease if they carry a genetic risk factor for the condition. It's important to note, however, that while the study found an association between eating more gluten early in life and celiac disease, it wasn't designed to prove a cause-and-effect relationship. Amount of Gluten Consumed The results of a recent study showed that every daily gram increase in gluten intake in 1-year olds increases the risk of developing celiac disease autoimmunity by 5%.- 9 comments
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Celiac.com 04/18/2022 - Several observational studies have indicated that celiac disease patients do not have higher susceptibility of COVID-19 and the risk of severe COVID-19. However, the the conclusions of such studies can be distorted by reverse causation and confounding, especially for newly-emerged diseases, such as COVID-19. A team of researchers recently set out to further clarify the picture using both observational and Mendelian Randomization analysis. The research team included Jiuling Li, Aowen Tian, Dandan Yang, Miaoran Zhang, Lanlan Chen, Jianping Wen, and Peng Chen. For their observational study, the team used data from the UK Biobank cohort. They conducted both univariate and multivariate logistic regression analysis to identify the risk factors for both COVID-19 susceptibility and severe COVID-19. They also conducted a two-sample Mendelian Randomization analysis to delineate causality between celiac disease and COVID-19 susceptibility and severe COVID-19. The good news is that the team's UK Biobank data revealed that celiac disease patients had a slightly lower overall susceptibility to COVID-19, and that celiac patients did not have higher rates of severe COVID-19. Meanwhile, the Mendelian Randomization study showed that celiac patients had lower susceptibility to both COVID-19 and fewer cases of severe COVID-19, although the lower COVID-19 susceptibility is seen in only in the UK Biobank cohort. These results indicate that people with celiac disease do not face higher risk of getting COVID-19, or of developing severe COVID, than the non-celiac population, and they likely do not need to take any extra COVID-19 precautions. Read more in Clin Transl Gastroenterology The researchers in this study are variously affiliated with the Department of Pathology, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Experimental Center of Pathogenobiology, Immunology, Cytobiology and Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Clinical Medicine of Jilin University in Changchun, Jilin, China; and the Department of Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China.
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Celiac.com 02/28/2022 - Immune regulation is important for carcinogenesis; however, the cancer risk profiles associated with immune-mediated diseases, like celiac disease, are not well understood. A team of researchers recently set out to assess the profiles of cancer risk associated with 48 immune-mediated diseases with the risk of total and individual cancers. They also assessed the prospective association of organ-specific immune-mediated diseases with the risk of local and extra-local cancers. The research team included Ming-ming He, MD; Chun-Han Lo, MD, MPH; Kai Wang, MD, PhD; Georgios Polychronidis, MD; Liang Wang, MD; Rong Zhong, PhD; Markus D. Knudsen, PhD; Zhe Fang, MD; and Mingyang Song, MD, ScD. For their prospective cohort study, the team used data from the UK Biobank cohort study on adults aged 37 to 73 years who were recruited at twenty-two assessment centers throughout the UK between January 1, 2006, and December 31, 2010, with follow-up through February 28, 2019. After adjusting for various potential confounders using time-varying Cox proportional hazards regression, the team assessed the connection between immune-mediated diseases with risk of cancer with multivariable hazard ratios (HRs) and 95% CIs. They used the contrast test method to assess heterogeneity in the associations of organ-specific immune-mediated diseases with local and extra-local cancers. In this group study of nearly half a million participants, the team found that immune-mediated diseases were associated with an increased total cancer risk. Organ-specific immune-mediated diseases showed higher associated risk of local cancers than extra-local cancers, and many immune-mediated diseases were associated with increased risk for cancer in the near and distant organs or other systems. Organ-specific immune-mediated diseases had stronger associations with risk of local cancers than extralocal cancers. The associations for individual immune-mediated diseases were largely organ specific, but were also seen for some cancers in the near and distant organs or different systems. Their findings suggest that immune-mediated diseases are associated with risk of cancer at the local and systemic levels, which supports the role of local and systemic immunoregulation in the development of cancers. Read more in JAMA Oncology The researchers are variously affiliated with the Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston; the Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston; the Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; the Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany; the Center of Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; the Division of Surgery, Department of Transplantation Medicine, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Oslo, Norway; and the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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Does Celiac Disease in Kids Mean Greater Psychiatric Risk?
Jefferson Adams posted an article in Spring 2017 Issue
Celiac.com 05/16/2017 - A number of studies have indicated that kids with celiac disease face an increased risk for mood disorders, anxiety and behavioral disorders, ADHD, ASD, and intellectual disability. A new study by a team of researchers in Sweden puts it more precisely. They put the increased risk for psychiatric disorders in children with celiac disease at 1.4-fold over kids without celiac disease. The research team assessed the risk of any type of childhood psychiatric disorders, including psychosis, mood, anxiety, and eating disorders, psychoactive substance misuse, behavioral disorder, ADHD, ASD, and intellectual disability, in children aged 18 and younger, along with their siblings. The researchers included Agnieszka Butwicka, MD, PhD, of the department of medical epidemiology and biostatistics, Karolinska Institute, Stockholm, Sweden, and colleagues. For each of the 10,903 children with celiac disease, the research team randomly selected 100 non-celiacs from the general population. These control subjects were then matched by gender and year and country of birth. For each of the 12,710 siblings of celiac disease subjects, the research team randomly assigned 100 healthy control siblings from the general population. These were also matched by gender, year and country of birth of both siblings. Both sets of siblings were required to be free of celiac disease to age 19. The researchers reviewed histological data on patients who showed villous atrophy in small intestine biopsy specimens between 1969 and 2008, and equated villous atrophy with celiac disease. In the main cohort study, the researchers estimated the risk for any psychiatric disease, as well as specific psychiatric disorders (ie, mood, anxiety, eating, and behavioral disorders, as well as neuropsychiatric disorders such as attention deficit hyperactivity disorder (ADHD), autistic spectrum disorders (ASD), and intellectual disability) in children with celiac disease, compared with general population controls. They used sibling analyses to assess whether underlying familiar factors could account for the associations. As a comparing factor, they compared the risk for psychiatric disorders in the siblings against the risk in siblings of the general population. The team conducted both univariate and multivariate analyses, adjusting for maternal/paternal age at the child's birth, maternal/paternal country of birth, level of education of highest-educated parent, and the child's gestational age, birthweight, Apgar score, and history of psychiatric disorders prior to recruitment. During follow-up, 7.7% of children were diagnosed with a psychiatric disorder. A positive association was found in the first univariate analysis between celiac disease and any psychiatric disorder, which remained even after the researchers adjusted for maternal/paternal age at childbirth and country of birth, parental education level, and child's gestational age, birthweight, Apgar score, and previous history of psychiatric disorders. The overall prevalence of psychiatric disease in the entire sample celiac disease patients was about 7%. That number remained steady in the 10 years after biopsy. However, once the researchers analyzed the findings by cohort, they found that rates of psychiatric disorders had actually increased 8-fold over that 10-year period. The siblings of celiac disease patients showed no increased risk for any psychiatric disorder. The study showed that psychiatric disorders "may precede a diagnosis of celiac disease in children." The research team called this finding "important." They write that their study also offers "insight into psychiatric comorbidities in childhood celiac disease over time." The study showed that children with celiac disease definitely faced an elevated risk for specific psychiatric disorders, including mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability. Although the study showed that patients with celiac disease are more likely to have prior psychiatric disorders, the team notes that they have yet to determine "the mechanisms underlying the association between celiac disease and psychiatric orders." The fact that the siblings of celiac disease patients showed no increased risk of psychiatric disorders indicates that these may be an "effect of celiac disease per se rather than common genetic or within-family environmental factors," the researchers add. The researchers conclude that their study "underscores the importance of both mental health surveillance in children with celiac disease and a medical workup in children with psychiatric symptoms." This study offers yet another piece in the complex puzzle that is celiac disease. It emphasizes the need for doctors and parents to remain on the lookout for potential psychiatric issues when dealing with children who have celiac disease. Source: Psychiatry Advisor-
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Celiac.com 02/02/2022 - A team of researchers performed a prior population-based mass screening of celiac disease in children aged 12 years in two birth groups, yielding nearly 300 seropositive cases, of which nearly 250 were diagnosed with celiac disease after duodenal biopsy. In a follow-up study, the research team recently set out to spot new cases in the screening population that originally tested negative. The team included patients who were seronegative at screening and later converted to diagnosed celiac disease, or patients who had potential celiac disease, that is, positive blood screen, but normal duodenal mucosa, and later converted to celiac disease. The research team included Olof Sandström, Fredrik Norström, Annelie Carlsson, Lotta Högberg, Maria van der Palz, Lars Stenhammar, Charlotta Webb, Anneli Ivarsson, and Anna Myléus. They are variously affiliated with the Department of Clinical Sciences, Paediatrics, Umea University, Umea, Sweden; the Department of Epidemiology and Global Health, Umea University, Umea, Sweden; the Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden; the Department of Clinical and Experimental Medicine, Paediatrics, Linköping University, Linkoping, Östergötland, Sweden; and the Department of Public Health and Clinical Medicine, Family Medicine, Umea University, Umea, Sweden. For their follow-up study, the team invited all children who tested seropositive to screen again, five years after the initial screen, including further serological testing, and biopsy for seropositive patients. The team used the National Swedish Childhood Coeliac Disease Register to find cases diagnosed in healthcare during the same period. In all, they assessed 12,353 seronegative children Out of 230 children who kept the follow-up appointment, including 34 of 39 with potential celiac disease, eleven children had converted to celiac disease. They found one new case in the register who was diagnosed via routine screening for type 1 diabetes. The team's five-year follow-up study shows that patients with potential celiac disease and positive celiac blood screens face a higher risk of developing celiac disease, while those with negative screens do not. Conversely, those with a negative screen enjoyed a very low risk for a clinical diagnosis over the following five years. Read more in the Archives of Disease in Childhood
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Celiac.com 01/17/2022 - People with autoimmune disorders face an elevated risk for celiac disease, but there's no clear data to show exactly how high that risk might be. To clarify the issue, a team of researchers recently set out to assess the incidence of autoimmune disorders in treated patients with celiac disease. The research team included Muhammad R. Khan; Shilpa S. Nellikkal; Ahmed Barazi; Joseph J. Larson; Joseph A. Murray; and Imad Absah. They are variously affiliated with the Division of Pediatric Gastroenterology and Hepatology; the Division of Biomedical Statistics and Informatics; and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. The team used the Rochester Epidemiology Project to conduct a retrospective medical record search for patients diagnosed with celiac disease at the Mayo Clinic's Olmsted Medical Center from January 1997 to December 2015. For each patient with celiac disease, the team assigned two non-celiac control subjects matched for age and sex during the study period. They used Kaplan-Meier analysis to determine the incidence rate of autoimmune disorder diagnosis five years after index date, for the celiac disease cases and controls. They then compared the results using the log-rank test. They found nearly 250 treated patients with celiac disease during the study period, matched to just under 500 matched control subjects. About one third of patients were boys. Within five years of the index date, 5.0% of celiac patients had a new autoimmune disorder diagnosis, compared with 1.3% of non-celiac control subjects. In the presence of a prior autoimmune disorder, the celiac disease group faced a much higher cumulative risk of a new or additional autoimmune disorder compared with control subjects. The data show that treated patients with celiac disease face a higher risk of developing autoimmune disorders than non-celiacs. The risk of a new autoimmune disorder is significantly higher in children, especially those with an existing autoimmune disorder. Read more: Journal of Pediatric Gastroenterology and Nutrition, October 2019 - Volume 69 - Issue 4 - p 438-442
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Celiac.com 09/20/2021 - People with celiac disease face an increased risk of death, in part due to cancer. Most studies investigating this cancer risk involved patients diagnosed before widespread increases in celiac disease diagnosis rates and access to gluten-free food. A team of researchers recently conducted a population-based study to assess the risk of cancer for people with celiac disease. For their study, the team used the Epidemiology Strengthened by histoPathology Reports in a Swedish cohort to gather data from all celiac disease patients in Sweden, with celiac disease defined as duodenal/jejunal villus atrophy. They then matched each patient by age, sex, and county to five or fewer control subjects. Then, following patients from diagnosis until first cancer, or by December 31, 2016, they calculated hazards ratios using the stratified Cox proportional hazards model. Of nearly 50,000 celiac patients, 64% were diagnosed with celiac disease since 2000. After a median follow-up of 11.5 years, the incidence of cancer was 6.5 and 5.7 per 1000 person-years in celiac disease patients and controls, respectively. The risk of cancer rose overall, but it was most sharply elevated in the first year after celiac disease diagnosis, and not later on, although the risks of hematologic, lymphoproliferative, hepatobiliary, and pancreatic cancers remained. Risk levels were highest for people diagnosed with celiac disease after age 60 years of age, while those diagnosed before age 40 faced no such increase. Lastly, the cancer risk was similar among those diagnosed with celiac disease before or after the year 2000. The team's data showed an overall rise in cancer risk for celiac disease patients, even in recent years. However, the risk increase is only for those diagnosed with celiac disease after age 40, and then mostly within the first year of diagnosis. This is one of the first studies to give a solid picture of overall cancer risks for people with celiac disease. Stay tuned for more on this and related stories. Read more in Clinical Gastroenterology and Hepatology The research team included Benjamin Lebwohl; Peter H.R. Green; Louise Emilsson; Karl Mårild; Jonas Söderling; Bjorn Roelstraete; and Jonas F. Ludvigsson. They are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; the Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Queen Silvia Children’s Hospital, Gothenburg, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 12/06/2021 - A correction was made to the article "64% were diagnosed with celiac disease since 2000."
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Celiac.com 12/22/2021 - In people with celiac disease, gluten sparks an immune reaction that causes damage to the small intestine, likely increasing their long-term risk of a number of gastrointestinal cancers. What about cancer risk when people without celiac disease eat gluten? The general assumption has been that gluten is basically healthy for those without gluten sensitivity. But researchers just don't know that much about the health impacts of gluten in the general population. A team of researchers recently set out to examine the association between gluten intake and risk of digestive system cancers among individuals without celiac disease. The research team included Yiqing Wang, Yin Cao, Benjamin Lebwohl, Mingyang Song, Qi Sun, Peter H.R. Green, Edward L. Giovannucci, Walter C. Willett, and Andrew T. Chan. For their study, the team used longitudinal data from three prospective cohorts, the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-Up Study. They estimated hazard ratios using Cox proportional regression, along with 95% confidence intervals of digestive system cancers, based on levels of gluten intake as determined by food frequency questionnaires. Over 4,801,513 person-years of follow-up, they found 6,231 incident digestive system cancer cases among three groups, and that gluten intake was not connected with an increased risk of digestive system cancer, even after adjusting for numerous risk factors, including body mass index, physical activity, diet quality. Similarly they found no connection for individual digestive system cancers, including oral cavity and oropharyngeal cancer, esophageal cancer, stomach cancer, small intestine cancer, colorectal cancer, pancreatic cancer, gallbladder cancer, and liver cancer. Gluten intake was not associated with any elevated risk of digestive system cancers in non-celiac adults. Avoiding or reducing dietary gluten is unlikely to help prevent digestive system cancers in non-celiacs. So, if you don't have celiac disease, avoiding gluten won't protect you from the kinds of digestive system cancers that are more common in people with celiac disease. Read more in Clinical Gastroenterology and Hepatology The researchers are variously affiliated with the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri ; the Division of Gastroenterology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri; the Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; the Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Celiac.com 11/09/2021 - A team of investigators recently set out to determine if patients with type 1 diabetes mellitus (T1DM) are at an increased risk of developing celiac disease compared with the general population. Their study, “Threshold for Undergoing Celiac Disease Diagnosis in Pediatric Type 1 Diabetes Mellitus Patients” was presented at the American College of Gastroenterology 2021 conference. The investigative team included Laurel Wood, MD, and colleagues variously affiliated with the University of Chicago. For the study, they reviewed chart data on patients under 21 years old who were diagnosed with both T1DM and celiac disease, and treated at University of Chicago. Data included patient diagnosis, pathologic results, serologic test results, and patient demographics. In all, 52% of patients were female, 86% were white, 5% were Hispanic or Latino, 5% were Asian, 3% were black, and 6% were of unknown ethnicity. The team found a total of sixty-three patients diagnosed with T1DM and celiac disease. Seven children diagnosed with T1DM who initially had negative celiac screening results became positive up to 7.25 years later, which shows the importance of regular screening. Typical T1DM patients received first celiac disease screening within an average of 2.29 years after their T1DM diagnosis. The diagnoses of celiac disease included sixteen cases by serology alone (16), thirty-nine by duodenal biopsy (39), and eight others. TTG and EMA showed a strong correlation, while high DGP IgA and DGP IgG were not necessarily the best indicators or duodenal mucosal damage in patients with T1DM. To more fully understand the usefulness of celiac disease antibodies in predicting severity of disease in T1DM children, the team suggests studies with larger samples of T1DM patients with Marsh scores less than 3 and increased celiac disease serology. They found that people with type 1 diabetes mellitus (T1DM) face a risk of developing celiac disease that is five to seven times higher than the general population. Read more at hcplive.com
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Celiac.com 10/18/2021 - Researchers and clinicians have promoted family screening as a way to reduce the significant under-diagnosis of celiac disease. However, good data for calculating the exact risk of the disease in relatives, and the effects of individual patient- and relative-related factors, remains scarce. A team of researchers recently set out to investigate the individual risk of celiac disease among relatives of celiac patients. The research team included Saana Paavola, Katri Lindfors, Laura Kivelä, Juliana Cerqueira, Heini Huhtala, Päivi Saavalainen, Riku Tauschi, Katri Kaukinen, and Kalle Kurppa. They are variously affiliated with the Faculty of Medicine and Health Technology at the University of Tampere and Tampere University Hospital in Tampere, Finland; the Faculty of Social Sciences at the University of Tampere in Tampere, Finland; the Translational Immunology Research Program, and Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland; and the University Consortium of Seinäjoki, Seinäjoki, Finland. The team assessed nearly three-thousand relatives of 624 index patients for evidence of prior celiac disease, or else screened for the disease. For each subject, the team was able to determine the celiac-associated human leucocyte antigen (HLA) genotype. They then used logistic regression to assess the connection between individual factors and new screening positivity. They found 229 previously diagnosed non-index relatives with celiac disease and 2,714 non-affected (2,067 first-degree, 647 more distant) relatives. Of these 2,714 relatives, 129 (nearly 5%) screened positive, with 5.1% of first-degree, 3.6% of second-degree, and 3.5% of more distant relatives. The combined rate of the previously diagnosed and now detected cases in relatives was just over 12%, and was evenly divided at about 6% for both clinically detected and screen-detected. Univariate analysis showed the main risk factors associated with screening positivity to be: under age 18 years at diagnosis, age 41–60 years, being a sibling, and having the high-risk genotype (3.22, 2.01–5.15 DQ2.5/2.5 or DQ2.5/2.2 vs other risk alleles) in relatives. Multivariable analysis showed that only high-risk HLA remained significant. From this study, the team concludes that unrecognized celiac disease is common for at-risk relatives, and also in relatives beyond first-degree, even where active case-finding prevails. By far, the most important predictor for screening positivity was the presence of the high-risk HLA genotype: 3.22, 2.01–5.15 DQ2.5/2.5 or DQ2.5/2.2. Read more in Aliment Pharmacol Ther. 2021;54(6):805-813.
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Celiac.com 09/21/2021 - Restaurants are one of the biggest challenges for people who need to eat gluten-free due to celiac disease or non-celiac gluten sensitivity. Pasta is one of the most commonly ordered restaurant dishes, and if gluten-free pasta is on the menu, it will definitely be popular for those with celiac disease. But what if the gluten-free pasta you order is boiled in the same water as they cook their traditional wheat pasta in? Did you ever wonder how much cross contamination there might be if this should happen? This scenario, unfortunately, happens more often than you might think. For example if the cook is new, or not properly trained, they might put your gluten-free linguini in the same pot of water that they just cooked regular wheat pasta in. This would obviously be a big problem for you, but just how big? Restaurants are still the biggest challenge for people who need to eat gluten-free due to celiac disease or gluten sensitivity, and many celiacs won't eat out because of such problems. A number of researchers have attempted to quantify cross-contamination risks for various food preparation activities, like a shared toaster that is used to prepare gluten-free toast. In a perfect world such things would never happen, but in reality it happens more often than most people realize. So how much cross contamination is there when this happens? Believe it or not, a team of researchers at the University of Nebraska ran some experiments to figure this out. The research team included Melanie Downs, Jennifer Clarke, Steve Taylor and then-UCARE (now doctoral) student Nate Korth. Interestingly, and perhaps counterintuitively, it turns out that shared water isn't as bad as you might expect. The team found that, even though gluten levels in the gluten-free penne rose slowly when boiling 52-gram servings over the course of five batches, those levels never exceeded 20 ppm. When boiling restaurant-sized servings, though, the gluten-free penne registered nearly 40 ppm after the fifth batch. So, for the first four batches, the pasta water remained below 20ppm gluten, then quickly rose to 40ppm after the fifth batch, perhaps due to gluten build-up in the water. Remember, the researchers are not trying to see how far restaurants can take it, but to attempt to quantify the risk levels for people with celiac disease, and no restaurant should ever do this. It's important to note that we're not recommending that anyone with celiac disease ever do this, or that any restaurant should ever do this, but it is important to quantify such risks for those with celiac disease. Regardless of what the researchers found, our recommendation is to always cook gluten-free pasta in dedicated, clean water that is kept totally separate from where traditional pasta is prepared, and to train all restaurant staff accordingly.
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Celiac.com 08/23/2021 - Ever worry about whether your doctor is properly knowledgeable about the risk of nutritional deficiencies for celiac patients on a gluten-free diet? A gluten-free diet offers the best symptom relief for patients with celiac disease, but a number of researchers and nutritionists have expressed concern about the potential for nutritional deficiencies for some patients. A team of researchers recently set determine how well medical students and healthcare professionals in Poland understand nutritional deficiencies, and the prevention of such deficiencies, in celiac patients on a gluten-free diet. The research team included Łukasz Dembiński, Artur Mazur, Mariusz Dąbrowski, Teresa Jackowska, and Aleksandra Banaszkiewicz. They are variously affiliated with the Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw in Warsaw, Poland; the College of Medical Sciences, University of Rzeszow in Rzeszów, Poland; and the Department of Pediatrics, Center of Postgraduate Medical Education in Warsaw, Poland. Because many gluten-free foods are high in fat, sugar and salt, and also have insufficient amounts of fiber, iron, vitamin D, and calcium, celiac patients on a gluten-free diet may be at risk for nutritional deficiencies. Nearly half of the 430 of the survey subjects did not realize that celiac patients may face a higher risk of nutritional deficiencies. The knowledge of those surveyed was lowest regarding the risk of celiacs being overweight or obese. Just over one in three of the healthcare professionals surveyed gave provided sufficiently correct answers, with the dietitians doing the best overall. The team's finding show that improvement is warranted in the education of healthcare professionals regarding nutrition in celiac patients on a gluten-free diet. Because celiac patients need prompt, proper treatment, and monitoring by health professionals, it is crucial that those professionals be properly educated on the issues and challenges faced by people with celiac disease, especially those on a gluten-free diet. Stay tuned for more on this and related stories. Read more in Nutrients 2021, 13(6), 1771
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