Natural history of celiac disease autoimmunity in a USA cohort followed since 1974.
BACKGROUND
The natural history and the possible changes of celiac disease (CD) prevalence over time are still unclear.


OBJECTIVE
1) To establish whether loss of tolerance to gluten may occur at any age; 2) to investigate possible changes of CD prevalence over time; and 3) to investigate CD-related co-morbidities.


METHODS
We analyzed 3,511 subjects with matched samples from 1974 (CLUE I) and 1989 (CLUE II). To avoid a selection bias regarding survival, we also screened 840 CLUE I participants who deceased after the 1974 survey. Outcome measure. CD autoimmunity (positivity to auto-antibodies) over time.


RESULTS
CD autoimmunity was detected in seven subjects in 1974 (prevalence 1:501) and in an additional nine subjects in 1989 (prevalence 1:219). Two cases of CD autoimmunity were found among the 840 subjects deceased after CLUE I. Compared to controls, untreated CD subjects showed increased incidence of osteoporosis and associated autoimmune disorders, but they did not reach statistical significance.


CONCLUSIONS
During a 15-year period CD prevalence increased 2-fold in the CLUE cohort and 5-fold overall in the US since 1974. The CLUE study demonstrated that this increase was due to an increasing number of subjects that lost the immunological tolerance to gluten in their adulthood.
Catassi
Carlo
C
Center for Celiac Research and Mucosal Biology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Kryszak
Debby
D
Bhatti
Bushra
B
Sturgeon
Craig
C
Helzlsouer
Kathy
K
Clipp
Sandra L
SL
Gelfond
Daniel
D
Puppa
Elaine
E
Sferruzza
Anthony
A
Fasano
Alessio
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000453:epidemiology*; D015551:Autoimmunity; D002446:Celiac Disease / Q000453:epidemiology* / Q000276:immunology*; D015331:Cohort Studies; D015897:Comorbidity; D019204:GTP-Binding Proteins / Q000276:immunology*; D005983:Glutens / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*; D014481:United States; D055815:Young Adult
D000906:Antibodies; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins