title: Coeliac disease characteristics, compliance to a gluten free diet and risk of lymphoma by subtype.
abstract: OBJECTIVE
  Coeliac disease is associated with an increased risk of malignant lymphomas. We investigated the importance of coeliac disease characteristics and diet compliance for risk of lymphoma.
  
  
  METHODS
  In a nested case-control design, we identified 59 patients with lymphoma and 137 matched controls from a population-based cohort of 11,650 inpatients with coeliac disease. We assessed coeliac disease characteristics at diagnosis and dietary compliance collected prospectively from medical records during follow-up.
  
  
  RESULTS
  Poor compliance was not significantly associated with risk of lymphoma overall (odds ratio 1.83, 95% confidence interval 0.78-4.31) nor of lymphoma subtypes. Risk estimates differed by subtype; risk of T-cell lymphoma (odds ratio 1.01, confidence interval 0.32-3.15) or intestinal lymphoma (odds ratio 0.66, confidence interval 0.17-2.56) was unelevated, whereas there was an indication of a risk increase of B-cell lymphoma (odds ratio 4.74, confidence interval 0.89-25.3) or extraintestinal lymphoma (odds ratio 3.00, confidence interval 0.73-12.3) following poor compliance. History of weight loss (odds ratio 2.89, confidence interval 1.00-8.29) at coeliac disease diagnosis was associated with an increased risk of lymphoma when excluding tumours occurring with short latency (<3 years).
  
  
  CONCLUSIONS
  Compliance to a gluten-free diet did not significantly alter lymphoma risk, but a moderate effect cannot be excluded. Weight loss, a potential marker of coeliac disease severity, may be associated with lymphoma risk.
authors: Sachs' Children's Hospital, Stockholm South General Hospital, Sweden. ola.olen@ki.se
authors: Ola
authors: O
authors: Olén
authors: Johan
authors: J
authors: Askling
authors: Jonas F
authors: JF
authors: Ludvigsson
authors: Hans
authors: H
authors: Hildebrand
authors: Anders
authors: A
authors: Ekbom
authors: Karin Ekström
authors: KE
authors: Smedby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy*; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D016015:Logistic Models; D008223:Lymphoma / Q000453:epidemiology / Q000209:etiology*; D016393:Lymphoma, B-Cell / Q000453:epidemiology / Q000209:etiology; D016399:Lymphoma, T-Cell / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult