Lower economic status and inferior hygienic environment may protect against celiac disease.
BACKGROUND
The populations in adjacent Russian Karelia and Finland are equally exposed to grain products and share partly the same ancestry, but live in completely different socioeconomic environments.


OBJECTIVE
This creates an ideal epidemiological setting to study gene-environmental interactions in pathogenesis of celiac disease.


METHODS
The prevalence of celiac disease and predisposing human leukocyte antigen (HLA) alleles was compared between Russian Karelia and Finland. Tissue transglutaminase antibodies and HLA-DQ alleles were screened from 1988 schoolchildren from Karelia and 3654 children from Finland. Children with transglutaminase antibodies were invited to small-bowel biopsy. Results. Transglutaminase antibodies were less frequent in Russian Karelia than in Finland (0.6% versus 1.4%, P = 0.005). Immunoglobulin class G (IgG) antigliadin antibodies were also less frequent in Russian Karelia (10.2% versus 28.3%, P<0.0001). Celiac disease was confirmed by duodenal biopsy in four of the eight transglutaminase antibody-positive Karelian children, giving a prevalence of 1 in 496 compared to 1 in 107 children in Finland. The same HLA-DQ alleles were associated with celiac disease and transglutaminase antibody positivity in both populations.


CONCLUSIONS
The prevalence of transglutaminase antibodies and celiac disease is lower in Russian Karelia than in Finland. This may be associated with a protective environment characterized by inferior prosperity and standard of hygiene in Karelia.
Kondrashova
Anita
A
Department of Virology, University of Tampere, Medical School, Tampere, Finland.
Mustalahti
Kirsi
K
Kaukinen
Katri
K
Viskari
Hanna
H
Volodicheva
Vera
V
Haapala
Anna-Maija
AM
Ilonen
Jorma
J
Knip
Mikael
M
Mäki
Markku
M
Hyöty
Heikki
H
D000293:Adolescent; D000483:Alleles; D001323:Autoantibodies / Q000276:immunology; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D004032:Diet; D004386:Duodenum / Q000473:pathology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005903:Gliadin / Q000276:immunology; D006683:HLA-DQ Antigens / Q000276:immunology*; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D015995:Prevalence; D012426:Russia / Q000453:epidemiology; D012959:Socioeconomic Factors; D011503:Transglutaminases / Q000276:immunology*
D001323:Autoantibodies; D006683:HLA-DQ Antigens; D007074:Immunoglobulin G; D005903:Gliadin; D011503:Transglutaminases