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Celiac.com 09/24/2012 - With all the problems that go along with celiac disease, it can be hard to see any benefits to having the disease. However, it would seem that such benefits do exist: a recent study in Sweden shows that women suffering from celiac disease are actually at a decreased risk of developing breast, endometrial and ovarian cancer. Data was collected from 28 Swedish pathology departments, identifying 17,852 biopsy-diagnosed women diagnosed with celiac disease between the years of 1969 and 2007. Women in the celiac group were age-matched and compared with a control group of 88,400 women. Risk of breast, endometrial and ovarian cancer were all estimated using the Cox regression model in both groups. Results showed an inverse relationship between celiac disease and all three forms of cancer. With breast cancer rates, women with celiac disease had a hazard ratio of 0.89 (meaning for every 100 women in the control group, only 89 in the celiac disease group developed breast cancer). Women with celiac disease also had a hazard ratio of 0.89 for ovarian cancer. For endometrial cancer, the decreased risk was even more pronounced with a hazard ratio of 0.6. All calculations carried a confidence interval of 95%. These numbers became even more pronounced after omitting the first year of followup after diagnosis (presumably the gluten-free diet 'adjustment period'). Breast cancer's hazard ratio fell to 0.82, ovarian cancer's hazard ratio fell to .72 and endometrial cancer's hazard ratio fell to 0.58. The study suggests that this negative correlation could be a result of shared risk factors or early menopause associated with celiac disease. Looking at the numbers though, particularly the 'adjustment period' drop off, one has to wonder if the gluten-free diet has some part to play in this as well. Source: http://www.ncbi.nlm.nih.gov/pubmed/21953605
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Celiac.com 05/12/2017 - The Gluten Intolerance Group (GIG) is an organization that certifies gluten-free products and food services. The GIG's latest definition and requirements for the product purity protocol was published by AACC International. The purity protocol defines the way of growing, harvesting and processing oats to keep them safe from gluten contamination, GIG's CEO, Cynthia Kupper, said. Until now, the term lacked a uniform definition, allowing companies who used it a degree of wiggle room. Under the new standard, companies will now have to provide documentation that prove the processes they follow are based on the newly standardized definition in order to use the claim 'purity protocol oats,' said Kupper. "Given the continuing growth of the market for gluten-free products, it is essential that terms like 'purity protocol' be defined for both food manufacturers and consumers," she added. Farmers collect higher fees for growing and managing oats under purity protocol conditions, and those higher prices usually get passed to consumers. Currently, the gluten-free products most commonly contaminated by wheat are granola and cookies that contain oats, Kupper told Bakery and Snacks. In addition to providing more confidence for consumers, the new protocol could lead to a price decrease, partly due to an expected increase in demand for products made with pure oats. That demand is partly driven by added consumer confidence in purity protocol products. In addition to tightening the purity protocols for oats, GIG plans to further standardize gluten-free screening for other grains, including rice, quinoa and other grains, according to the organization. Keep an eye on purity protocol oats to see if the predictions of lower prices, higher consumer confidence and safer oats hold true, and if so, whether those protocols can be applied to grains like rice and quinoa. Read more at BakeryandSnacks.com.
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Celiac.com 11/03/2014 - Some data have suggested that introducing gluten to infants at 4 to 6 months of age can help to lower the risk of celiac disease. To get a clearer picture of any potential benefits of introducing gluten within this time period, a team of researchers performed a multi-center, randomized, double-blind, placebo-controlled dietary-intervention study. The research team included Sabine L. Vriezinga, M.D., Renata Auricchio, M.D., Enzo Bravi, M.S., Gemma Castillejo, M.D., Anna Chmielewska, M.D., Ph.D., Paula Crespo Escobar, B.Sc., Sanja KolaÄek, M.D., Ph.D., Sibylle Koletzko, M.D., Ph.D., Ilma R. Korponay-Szabo, M.D., Ph.D., Eckart Mummert, Ph.D., Isabel Polanco, M.D., Ph.D., Hein Putter, Ph.D., Carmen Ribes-Koninckx, M.D., Ph.D., Raanan Shamir, M.D., Ph.D., Hania Szajewska, M.D., Ph.D., Katharina Werkstetter, M.Sc., M.P.H., Luigi Greco, M.D., Ph.D., Judit Gyimesi, M.D., Corina Hartman, M.D., Caroline Hogen Esch, M.D., Ph.D., Erica Hopman, R.D., Ph.D., Anneli Ivarsson, M.D., Ph.D., Tunde Koltai, Ir., Frits Koning, Ph.D., Eva Martinez-Ojinaga, M.D., Chantal te Marvelde, B.Sc., Ana Pavic, M.D., Jihane Romanos, Ph.D., Els Stoopman, Vincenzo Villanacci, M.D., Ph.D., Cisca Wijmenga, Ph.D., Ricardo Troncone, M.D., Ph.D., and M. Luisa Mearin, M.D., Ph.D. For their study, the team recruited 944 children who were positive for HLA-DQ2 or HLA-DQ8, with at least one first-degree relative with celiac disease. From 16 to 24 weeks of age, 475 participants received 100 mg of immunologically active gluten daily, and 469 received placebo. The team then made periodic measurements of anti–transglutaminase type 2 and antigliadin antibodies. The overall goal was to determine the frequency of biopsy-confirmed celiac disease at 3 years of age. The team confirmed celiac disease through biopsy in 77 children, while three more received a celiac diagnosis of based on the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for a total of 80 celiac children. The cumulative incidence of celiac disease among patients 3 years of age was 5.2% (95% confidence interval [CI], 3.6 to 6.8), with similar rates in the gluten group and the placebo group (5.9% [95% CI, 3.7 to 8.1] and 4.5% [95% CI, 2.5 to 6.5], respectively; hazard ratio in the gluten group, 1.23; 95% CI, 0.79 to 1.91). Both groups also showed similar rates of elevated levels of anti–transglutaminase type 2 and antigliadin antibodies (7.0% [95% CI, 4.7 to 9.4] in the gluten group and 5.7% [95% CI, 3.5 to 7.9] in the placebo group; hazard ratio, 1.14; 95% CI, 0.76 to 1.73). The team also noted that breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, had no substantial impact on the later development of celiac disease. Compared to the placebo, introducing small quantities of gluten to high-risk children at 16 to 24 weeks of age had no impact on rates of celiac disease at 3 years of age. So, basically, the data show that there is no need for parents to fret or worry about when their child first begins to consume gluten. There is no magic window or timeframe for introducing gluten to their child’s diet that will change the risk for developing celiac disease later on. Source: N Engl J Med 2014; 371:1304-1315October 2, 2014. DOI: 10.1056/NEJMoa1404172
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Can a Gluten-free Diet Lower the Risk of Diabetes?
Jefferson Adams posted an article in Diabetes and Celiac Disease
Celiac.com 07/14/2014 - Early life intestinal problems have previously been shown to influence diabetes rates. There is also some evidence that a gluten-free diet can lower rates of diabetes, but just how strong is the influence of gluten-free diet on the development of diabetes? A recent study by a group of researchers in Denmark suggests that maternal gluten-free diet greatly reduces inflammation and rates of diabetes in the offspring of certain mice. This study led the team to hypothesize that a gluten-free diet, which is known to decrease type 1 diabetes incidence, may also offer protection against diabetes when followed during the pregnancy and lactation period. The research team included Camilla H.F. Hansen, Åukasz Krych, Karsten Buschard, Stine B. Metzdorff, Christine Nellemann, Lars H. Hansen, Dennis S. Nielsen, Hanne Frøkiær, Søren Skov and Axel K. Hansen. They are variously affiliated with the Department of Veterinary Disease Biology of the Faculty of Health and Medical Sciences at the University of Copenhagen, the Department of Food Science, Faculty of Science, University of Copenhagen, the Department of Biology, Faculty of Science, University of Copenhagen, the Division of Toxicology and Risk Assessment of the National Food Institute at the Technical University of Denmark in Søborg, Denmark, and the Bartholin Institute in Copenhagen, Denmark. For their study, the team fed pregnant non-obese diabetic (NOD) mice either a gluten-free diet, or a standard diet, until all pups were weaned to standard diet. Overall, mice which experienced early life gluten-free diets had dramatically lower rates of diabetes and insulitis. An analysis of gut microbiota using 16S rRNA gene sequencing showed a major difference between both mothers and their offspring, marked by higher levels of Akkermansia, Proteobacteria, and TM7 in the gluten-free diet group. Gluten-free fed offspring showed increased M2 macrophage gene markers and tight junction-related genes in the gut, along with higher levels of pancreatic FoxP3 regulatory T cells. Gluten-free offspring also had reduced intestinal gene expression of proinflammatory cytokines. Finding more T cells in the pancreas expressing the mucosal integrin α4β7 suggests that this is due to an increase in gut-primed immune cells moving to the pancreas. The study shows clearly that a gluten-free diet during the fetal and early postnatal life lowers rates of diabetes. This may be due to a change in gut microbiota and a reduction in pro-inflammatory conditions in the gut and pancreas. Clearly, further study is needed to better understand the factors at play, and how they relate to diabetes reduction efforts. Source: American Diabetes Association. doi: 10.2337/db13-1612 -
Celiac.com 05/25/2012 - A team of researchers recently set out to examine body mass and obesity risk in a large population of people with celiac disease who are following a gluten-free diet. The research team included T. A. Kabbani, A. Goldberg, C. P. Kelly, K. Pallav, S. Tariq, A. Peer, J. Hansen, M. Dennis & D. A. Leffler. They are affiliated with the Department of Medicine and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Diagnosis for celiac disease is on the rise, and many people who are diagnosed experience weight changes once they adopt a gluten-free diet. There's a pretty good amount of study data on weight change on a gluten-free diet, but a very limited amount of data regarding changes in body mass. The researchers wanted to look at a large population of people with celiac disease, who followed a gluten-free diet to better understand changes in body mass index (BMI) following celiac diagnosis. To do this, they looked at a total of 1018 patients with biopsy confirmed celiac disease. The patients had all previously visited the Beth Israel gastroenterology clinic in Boston. The team recorded data for initial and follow-up BMIs, and used an expert dietitian to assess patient compliance with a gluten-free diet. They found a total of 679 patients with at least two recorded BMIs and GFD adherence data, and used data from those patients in their study. The average amount of time from first BMI measurement to follow-up measurement was 39.5 months. When they compared the results against data for the general population, they found that celiac disease patients on a gluten-free diet were significantly less likely to be overweight or obese (32% vs. 59%, P < 0.0001). They also found that average body mass increased significantly after patients adopted a gluten-free diet (24.0 to 24.6; P < 0.001). Overall, 21.8% of patients with normal or high BMI at study entry increased their BMI by more than two points. The results of this study show that celiac disease patients on a gluten-free diet have lower BMI than the regional population at diagnosis, but that BMI increases with a gluten-free diet, especially in those who follow the diet closely. Still, even though overall risk of obesity is lower than the regular population, once celiac patients adopt a gluten-free diet, 15.8% of patients move from a normal or low BMI class into an overweight BMI class, and 22% of patients overweight at diagnosis gain weight. As a result, the study team feels that weight maintenance counseling should be an integral part of celiac dietary education. Source: Alimentary Pharmacology & Therapeutics. 2012;35(6):
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Celiac.com 05/27/2013 - A team of researchers recently investigated whether celiac disease influences risk for non–insulin-dependent diabetes mellitus (NIDDM) and metabolic syndrome. To do so, they examined the prevalence of NIDDM and metabolic syndrome among adults with celiac disease, compared with healthy matched control subjects. The research team included Toufic A. Kabbani, Ciaran P. Kelly, Rebecca A. Betensky, Joshua Hansen, Kumar Pallav, Javier A. Villafuerte–Gálvez, Rohini Vanga, Rupa Mukherjee, Aileen Novero, Melinda Dennis, and Daniel A. Leffler. They are variously affiliated with the Celiac Center, Department of Medicine, Division of Gastroenterology at Beth Israel Deaconess Medical Center, and the Harvard School of Public Health in Boston, Massachusetts. For their study, the team assessed medical records of 840 patients with biopsy-proven celiac disease for diagnoses of NIDDM, hypertension, or hyperlipidemia; body mass index (BMI); lipid profile; and levels of glucose or glycosylated hemoglobin, to identify those with metabolic syndrome. They matched 840 healthy control subjects for age, sex, and ethnicity. They then compared rates of NIDDM and metabolic syndrome in the celiac disease cohort with that of the controls and subjects included in the National Health and Nutrition Examination Survey. The team found that 26 patients with celiac disease (3.1%) had NIDDM compared with 81 controls (9.6%) (P less than .0001). Similarly, patients with celiac disease had lower rates of metabolic syndrome compared with the control group (3.5% vs 12.7%; P less than .0001). The average BMI of patients with celiac disease was substantially lower than the BMI of control subjects (24.7 vs 27.5; P less than .0001). However, even after controlling for BMI, celiac disease patients still had a lower risk of developing NIDDM, compared with non-celiac patients. From this study, the team concludes that rates of NIDDM and metabolic syndrome are lower among patients with celiac disease than in matched controls and the general population. These differences are not explained by differences in BMI. Further study is important so that researchers can determine exactly how celiac disease affects the risk for NIDDM and metabolic syndrome. Source: Gastroenterology, Volume 144, Issue 5, Pages 912-917.e1, May 2013
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Celiac.com 04/12/2013 - A number of studies have suggested a connection between infant feeding patterns and the development or clinical expression of celiac disease. However, until recently, it remained unclear whether infant feeding actually affects the occurrence and/or the clinical presentation of celiac disease. A recent study that shows important differences in celiac disease rates between two groups of 12-year-olds indicates a possible strategy for preventing celiac disease. The notable difference between the two groups was simple infant feeding practices. The study findings suggest that gradual introduction of gluten in small amounts during ongoing breastfeeding provides protection against celiac disease. The study was conducted by Anneli Ivarsson, MD, PhD; Anna Myléus, MD, PhD; Fredrik Norström, PhD; Maria van der Pals, MD; Anna Rosén, MD, PhD; Lotta Högberg, MD, PhD; Lars Danielsson, MD; Britta Halvarsson, MD, PhD; Solveig Hammarroth, MD; Olle Hernell, MD, PhD; Eva Karlsson, MD; Lars Stenhammar, MD, PhD; Charlotta Webb, MD; Olof Sandström, MD, PhD; and Annelie Carlsson, MD, PhD. They are variously affiliated with the Departments of Public Health and Clinical Medicine, Epidemiology and Global Health, Medical Biosciences, Clinical and Medical Genetics, and Clinical Sciences, Pediatrics at Umeå University in Umeå, Sweden; the Department of Pediatrics in Clinical Sciences at Skånes University Hospital at Lund University, in Lund, Sweden; the Pediatric Clinic of Norrköping Hospital in Norrköping, Sweden, the Department of Clinical and Experimental Medicine in the Division of Pediatrics at Linköping University in Linköping, Sweden; the Pediatric Clinic of Norrtälje Hospital in Norrtälje, Sweden; the department of Pathology and Cytology of Aleris Medilab in Täby, Sweden; and the Pediatric Clinic of Växjö Hospital in Växjö, Sweden. To accomplish their goal, the team crafted a 2-phase cross-sectional screening study of 13,279 children from two separate birth groups: the first born during the Swedish celiac disease epidemic of 1993, and the second born in 1997, after the epidemic ended. The team investigated and compared the overall rates of celiac disease in the two groups, each at twelve years old, and compared the results against each group's ascertained infant feeding patterns. To report and confirm all previously diagnosed cases of celiac disease, they analyzed blood samples for serological markers of celiac disease, and referred all children with positive values for small intestinal biopsy. The team used questionnaires to determine infant feeding practices for both groups. They expressed prevalence comparisons as prevalence ratios, and found that the total prevalence of celiac disease was 29 in 1000 for the 1993 group, and and 22 in 1000 1997 group. Children born in 1997 substantially less likely to develop celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% conï¬dence interval: 0.60–0.93; P = .01). Again, the difference between the groups was in infant feeding patterns. Specifically, the groups differed in the percentages of infants introduced to dietary gluten in small amounts during ongoing breastfeeding. Many more children in the 1997 group had gluten introduced into their diets in small amounts during ongoing breastfeeding, as compared to the 1993 group. Overall, the signiï¬cantly lower rates of celiac disease in the 1997 group indicate that gradual introduction of gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, offers a possible way to prevent or lower celiac disease risk. Source: Pediatrics 2013;131:e687–e694. doi: 10.1542/peds.2012-1015
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Celiac.com 10/12/2012 - What is the relationship between breastfeeding, the age of gluten introduction and rates of celiac disease? A number of studies have shown that increased breastfeeding may provide some protection against celiac disease. However, one study found no change in the overall prevalence of celiac disease in breastfed infants compared to controls, suggesting that breastfeeding may only delay the presentation of the disease but, does not prevent it. Other studies show no significant difference in the prevalence of celiac disease between breastfed and non-breastfed patients. Data from the Swedish celiac disease epidemic suggest a 3% prevalence of celiac disease in the children born during the epidemic. An analysis by Ivarsson et al. of children born during the epidemic, found that children under 2 years of age had a lower risk of celiac disease if they were still being breastfed when dietary gluten was introduced (odds ratio 0.59, 95, with a confidence interval 0.42–0.83). Children who continued breastfeeding after gluten was introduced to their diet showed a further decrease in the risk for celiac disease (OR 0.36, 95% CI 0.26–0.51). A meta-analysis that included the Ivarsson data, showed celiac disease risk was significantly lower in infants who were breastfed at the time of gluten introduction (pooled OR 0.48, 95% CI 0.40–0.59), compared to infants who were not breastfed at the time of first gluten exposure. A later study, by Akobeng and others, estimated that breastfeeding all babies in the UK at the time of gluten introduction, would prevent 2500 cases of celiac disease every year. The best data currently available on celiac disease and the age of gluten introduction comes from a prospective study by Norris et al. The study followed 1560 children in Denver between 1994 and 2004. This study showed that children exposed to gluten in the first 3 months of life had a fivefold increased risk of having celiac disease than children exposed to gluten between 4 and 6 months of age, while children exposed to gluten at 7 months old or later had an almost twofold increased risk compared with those exposed at 4 to 6 months (hazard ratio 1.87, 95% CI 0.97–3.60). When the analysis was limited to biopsy-diagnosed celiac disease, the hazard ratio was 23.97 (95% CI 4.55–115.9) for children exposed to gluten during the first 3 months of life compared to the 4–6 months exposure group, and 3.98 (95% CI 1.18–13.46) in the group exposed at 7 months or later What remains unclear, is whether breastfeeding and the age of introduction of gliadin prevent celiac disease or merely delay its onset. To clarify the relationship between breastfeeding, the age at which gluten is introduced into the diet, and celiac disease, the EU has funded a prospective study, called PREVENTCD, FP6, in 10 European centers. The PREVENTCD study recruited pregnant women with a family history of celiac disease, and determined HLA4 of the newborn at birth. By the end of December 2010, researchers had recruited a total of 1345 children at birth and enrolled 986 with positive HLA DQ status. Researchers instructed mothers to breastfeed for 6 months, if possible. Beginning at the age of 4 months, the researchers placed the infants into randomized study groups, and fed them 100 mg of gliadin or a non-gliadin placebo every day. The full data won't be available until all children reach the age of 3 years of age, but the researchers hope that the study will offer definitive answers on the relationship between breastfeeding and the age of gluten introduction and rates of celiac disease. Until new information become available, the ESPGHAN Committee on Nutrition recommendations remain in effect. This recommendations state that gluten should be introduced to infants no earlier than 4 months of age, and no later than 7 months, and that the introduction should be gluten be made while the infant is still being breastfed. This information was compiled by researcher R. Shamir of the Institute for Pediatric Gastroenterology, Nutrition and Liver Diseases, at the Schneider Children's Medical Center of Israel, Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University in Ramat Aviv, Israel. Source: Isr Med Assoc J. 2012 Jan;14(1):50-2.
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Celiac.com 06/08/2011 - A team of researchers recently set out to determine whether delaying gluten introduction in infants with genetic risk for islet autoimmunity is feasible, safe, and able to reduce the risk of type 1 diabetes–associated islet autoimmunity. The research team included Sandra Hummel, PHD, Maren Pflüger, PHD, Michael Hummel, MD, Ezio Bonifacio, PHD, and Anette-G. Ziegler, MD. They are variously affiliated with the Institute for Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes der Technischen Universität München, the Institut für Diabetesforschung der Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany, and the Deutsche Forschungsgemeinschaft Center for Regenerative Therapies Dresden, Technische Universität Dresden, Germany. For the study, the team recruited a total of 150 infants with a first-degree family history of type 1 diabetes and a risk HLA genotype. They then randomly assigned each infant to a first gluten exposure at age 6 months (control group) or 12 months (late-exposure group). The team followed-up on each infant at three month-intervals until the age of 3 years, and then yearly thereafter. The team tested for growth and autoantibodies to transglutaminase C [TGCAs]), islet autoantibodies to insulin, GAD, insulinoma-associated protein 2, and type 1 diabetes. A total of 70% of families reported following the dietary-intervention protocol. For the first three years, children in the control and late-exposure groups showed similar weight and height, along with similar probability of developing TGCAs (14 vs. 4%; P = 0.1). A total of eleven children in the control group and 13 children in the late-exposure group developed islet autoantibodies (3-year risk: 12 vs. 13%; P = 0.6). Seven children developed diabetes, including four in the late-exposure group. The team saw no significant differences when analyzing children as per protocol on the basis of the first reported reported gluten exposures for the children. From the data, the team concluded that delaying gluten exposure until the age of 12 months is safe, but does not significantly reduce the likelihood of islet autoimmunity in genetically at-risk children. Source: DiabetesCare.com
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Drug May Lower Gluten Toxicity in Patients with Celiac Disease
Jefferson Adams posted an article in Latest Research
Celiac.com 04/18/2012 - Biopharmaceutical development company, BioLineRx, has announced results from pre-clinical trials which show that their compound, BL-7010, an orally available treatment for celiac disease, reduces the toxic effects of gluten in patients with celiac disease. The findings, which appear in the February issue of Gastroenterology, show that BL-7010, which was previously labeled P(HEMA-co-SS, lowers gluten toxicity by reducing the body's digestion of wheat gluten. The findings also show that BL-7010 also improves the immune response to gluten in rodents, as well as preventing gluten-induced pathological damage to the small intestine. Furthermore, they note that BL-7010 is not absorbed systemically, indicating that its gluten-neutralizing effects are likely safe. These data demonstrate BL-7010's therapeutic potential for reducing or blocking gluten-induced disorders in humans with celiac disease. Because it can be difficult to maintain a life-long, strict, gluten-free diet, the fact that BL-7010 may attenuate the immune response to gluten and reduce subsequent damage to the small intestine, suggests that this drug, or others like it may be useful in improving quality of life for millions of celiac disease patients. Source: http://www.news-medical.net/news/20120222/BioLineRx-BL-7010-may-reduce-gluten-toxicity-in-patients-with-celiac-disease.aspx- 5 comments
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Celiac.com 10/07/2011 - A number of studies suggest that women with celiac disease have reproductive difficulties, but data have been inconclusive and contradictory. A research team recently set out to assess fertility in women with biopsy-verified celiac disease. The study team included Daniela Zugna, Lorenzo Richiardi, Olof Akre, Olof Stephansson, and Jonas F Ludvigsson. They are affiliated variously with the Cancer Epidemiology Unit at the Centre for Experimental Research and Medical Studies and Centre for Oncologic Prevention at the University of Turin in Turin, Italy, the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden, and with Clinical Epidemiology Unit of the Department of Medicine, the Department of Molecular Medicine and Surgery, the Division of Obstetrics and Gynaecology, and the Department of Women's and Children's Health at the Karolinska Institutet in Karolinska, Sweden. For their Swedish population-based cohort study, the team gathered data all 28 pathology departments in Sweden on 18,005 biopsy-proven duodenal/jejunal biopsy, using Marsh III, villous atrophy as their baseline. They also established a control group of 51,109 age-matched women without celiac disease. They then found 11,495 women with celiac disease who were aged 18–45 years. The team used multinomial logistic regression and Cox regression to estimate fertility in these women compared with the age-matched reference women. The team defined 'fertility' as the number of children according to the Swedish Multi-Generation Register. Their results showed that women with celiac disease had 16,309 births compared with 69,245 for the reference group. Overall, the total number of children in the group of women with celiac disease was slightly higher compared with the reference group. Adjusting for age, calendar period and parity and stratifying by education, the overall fertility hazard ratio (HR) for women with celiac disease was 1.03 (95% CI 1.01 to 1.05). Specifically, the fertility HR was 1.05 (95% CI 0.96 to 1.14) for celiac disease diagnosed in women under 18-years of age, 1.04 (95% CI 1.01 to 1.07) for celiac disease diagnosed in women between 18 and 45 years, and 1.02 (95% CI 0.99 to 1.04) for celiac disease diagnosed in women >45 years of age. Factoring in the dates of celiac disease diagnosis, fertility was decreased 0–2 years before time of diagnosis (HR=0.63; 95% CI 0.57 to 0.70), but was identical to that of controls 0–5 years subsequent to diagnosis and increased to 1.12 (95% CI 1.03 to 1.21) thereafter. The data for this study show that women with celiac disease had a normal fertility, but their fertility was decreased in the last two years before diagnosis. Interestingly, fertility in women with celiac disease was also slightly higher after five years, comported to the control group. Stay tuned... Source: Gut 2010;59:1471-1475. doi:10.1136/gut.2010.219030
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Celiac.com 03/04/2011 - Celiac disease is similar to the inflammatory bowel diseases, ulcerative colitis and Crohn’s disease, in the obvious sense that all are chronic inflammatory disorders of the gastrointestinal tract. But more than that, they all also present daily psychological and social challenges to patients’ lifestyles. In a recent study reported in the European Journal of Gastroenterology and Hepatology, researchers in the United Kingdom examined the prevalence of GI symptoms in patients with these diseases and correlated the incidence of these symptoms with quality of life (QoL). Not surprisingly, they found that increased severity of reflux and irritable bowel syndrome were associated with a diminished QoL. Patients with celiac disease had worse symptoms and QoL than those with ulcerative colitis, but they were better off than people with Crohn’s disease. This cross-sectional study was performed by sending patients surveys through the mail. One thousand and thirty-one people were included; 225 patients with celiac, 228 with ulcerative colitis, 230 with Crohn’s disease, and 348 healthy age- and sex-matched controls. As this was a postal survey, there is a potential inclusion bias – it is possible that those patients faring the worst would be most likely to send back the questionnaires. Seventy one percent of the celiac patients reported adhering to a gluten-free diet, but this was not corroborated endoscopically. One of the surveys assessed physical and mental QoL and another considered depression and anxiety. Participants were also asked to report and rate GI symptoms they had experienced over the past month, including reflux, heartburn, regurgitation, belching, dysphagia (difficulty swallowing), and retrosternal pain. Barrat et al. found that the celiac patients had higher rates of belching and dysphagia than inflammatory bowel diseases sufferers in this study and also than reported previously. They highlight that despite the high (71%) degree of adherence to the gluten-free diet, 22% of celiac patients still reported severe enough IBS symptoms to affect their QoL. They infer from this finding a couple of noteworthy things. First, that the gluten-free diet may not adequately control IBS symptoms in celiac patients. But also, that doctors are perhaps not inquiring about reflux and IBS during consultations, or patients are under-reporting their prevalence. The authors thus suggest that QoL might be improved for these patients if doctors were more diligent in assessing them for reflux and irritable bowel syndrome. Source: European Journal of Gastroenterology & Hepatology: February 2011 - Volume 23 - Issue 2 - p 159–165
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Are there any unique factors to be considered for children? (I've heard that the serology has a lower predictive value for children under age two, since IgA may be depressed, or with anyone who has a condition which depresses IgA.)**
Scott Adams posted an article in Frequently Asked Questions About Celiac Disease
Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: Not really. It is not true that the serological methods have lower predictive value in children less than two years of age. In all the studies that we did, there was 100% correlation of the EMA to the disease activity irrespective of the age. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: There are age dependent changes in several blood parameters during childhood. It is well known that immunoglobulin levels depend on the age of children. E.g. the IgA class immunoglobulins reach the adult level only by 16 years of age, and the blood level of IgA immunoglobulins is only 1/5th of adult value below two years of age. A large study from Europe (Brgin-Wollf et al. Arch Dis Child 1991;66:941-947) showed that the endomysium antibody test is less specific and sensitive in children below two years of age. They found that the sensitivity of the EmA test decreased from 98% to 88% in children younger than 2 years of age. It means that 12% of their patients with celiac disease, who were younger than two years of age, did not have an increase in their endomysium antibody levels.
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