Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic.
OBJECTIVE
Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases.


METHODS
All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease.


RESULTS
Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33).


CONCLUSIONS
The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.
Myléus
Anna
A
Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden. anna.myleus@epiph.umu.se
Ivarsson
Anneli
A
Webb
Charlotta
C
Danielsson
Lars
L
Hernell
Olle
O
Högberg
Lotta
L
Karlsson
Eva
E
Lagerqvist
Carina
C
Norström
Fredrik
F
Rosén
Anna
A
Sandström
Olof
O
Stenhammar
Lars
L
Stenlund
Hans
H
Wall
Stig
S
Carlsson
Annelie
A
D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology
D005983:Glutens