title: Prevalence of childhood celiac disease and changes in infant feeding.
abstract: OBJECTIVE
  Between 1984 and 1996, Sweden experienced an "epidemic" of clinical celiac disease in children <2 years of age, attributed partly to changes in infant feeding. Whether infant feeding affects disease occurrence and/or the clinical presentation remains unknown. We investigated and compared the total prevalence of celiac disease in 2 birth cohorts of 12-year-olds and related the findings to each cohort's ascertained infant feeding.
  
  
  METHODS
  A 2-phase cross-sectional screening study was performed in which 13 279 children from 2 birth cohorts participated: children born during the epidemic (1993) and children born after the epidemic (1997). Previously diagnosed cases were reported and confirmed. Blood samples were analyzed for serological markers and children with positive values were referred for small intestinal biopsy. Infant feeding practices in the cohorts were ascertained via questionnaires. Prevalence comparisons were expressed as prevalence ratios.
  
  
  RESULTS
  The total prevalence of celiac disease was 29 in 1000 and 22 in 1000 for the 1993 and 1997 cohorts, respectively. Children born in 1997 had a significantly lower risk of having celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% confidence interval: 0.60-0.93; P = .01). The cohorts differed in infant feeding (specifically, in the proportion of infants introduced to dietary gluten in small amounts during ongoing breastfeeding).
  
  
  CONCLUSIONS
  A significantly reduced prevalence of celiac disease in 12-year-olds indicates an option for disease prevention. Our findings suggest that the present infant feeding recommendation to gradually introduce gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, is favorable.
authors: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden. anneli.ivarsson@epiph.umu.se
authors: Anneli
authors: A
authors: Ivarsson
authors: Anna
authors: A
authors: Myléus
authors: Fredrik
authors: F
authors: Norström
authors: Maria
authors: M
authors: van der Pals
authors: Anna
authors: A
authors: Rosén
authors: Lotta
authors: L
authors: Högberg
authors: Lars
authors: L
authors: Danielsson
authors: Britta
authors: B
authors: Halvarsson
authors: Solveig
authors: S
authors: Hammarroth
authors: Olle
authors: O
authors: Hernell
authors: Eva
authors: E
authors: Karlsson
authors: Lars
authors: L
authors: Stenhammar
authors: Charlotta
authors: C
authors: Webb
authors: Olof
authors: O
authors: Sandström
authors: Annelie
authors: A
authors: Carlsson
mesh_terms: D000367:Age Factors; D001942:Breast Feeding / Q000639:trends*; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007225:Infant Food; D008297:Male; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology
chemical_list: D005983:Glutens