title: Natural history of celiac disease autoimmunity in a USA cohort followed since 1974.
abstract: 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.
authors.affiliation: Center for Celiac Research and Mucosal Biology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
authors.forename: Debby
authors.initials: D
authors.lastname: Kryszak
authors.forename: Bushra
authors.initials: B
authors.lastname: Bhatti
authors.forename: Craig
authors.initials: C
authors.lastname: Sturgeon
authors.forename: Kathy
authors.initials: K
authors.lastname: Helzlsouer
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Clipp
authors.forename: Daniel
authors.initials: D
authors.lastname: Gelfond
authors.forename: Elaine
authors.initials: E
authors.lastname: Puppa
authors.forename: Anthony
authors.initials: A
authors.lastname: Sferruzza
authors.forename: Alessio
authors.initials: A
authors.lastname: Fasano
mesh_terms: 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
chemical_list: D000906:Antibodies; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins