Prevalence and Natural History of Celiac Disease in a Cohort of At-risk Children.
To assess the prevalence and clinical presentation of celiac disease (CD) in a cohort of children with HLA-DQ2 positive and evaluate the risk factors in the development of CD.



Between July 2004 and July 2005, parents of all healthy full-term newborns in our hospital were invited to participate. HLA-DQ2 was tested in blood sample of the umbilical cord. A point of contact serological test was performed on children between 2 and 3 years of age. Positive results were confirmed by serum anti-transglutaminase 2 and endomysial antibodies. Children with high autoantibody titers underwent an intestinal biopsy. Children of the cohort diagnosed with CD before the screening study were included. Sex, mode of delivery, breast-feeding duration, and age of gluten introduction were studied.



Of 1291 children, 362 were HLA-DQ2 positive and 262 participated in the study. CD was diagnosed in 4.1% (95% confidence interval (CI) 1.9-6.3). In the whole cohort, 60% had gastrointestinal symptoms, 7% poor weight gain, and 33% were asymptomatic. Five children with potential CD and 6 with CD autoimmunity became negative (42.3%) and are still negative after 5 to 7 years. Female sex was at-risk factor odds ratio 5.7 (95% CI 1.5-20.9), whereas breast-feeding during gluten introduction had a protective effect odds ratio 0.1 (95% CI 0.01-0.8).



Prevalence of CD in this cohort was 4%, half of whom had digestive symptoms. Because a high proportion of children showed a spontaneous disappearance of antibodies, prevalence studies of CD in young children should be based on intestinal damage so as not to overestimate results.
*Department of Pediatrics, Puerta de Hierro University Hospital †Department of Pediatrics ‡Department of Biochemistry, Severo Ochoa University Hospital, Madrid, Spain.
María Luz
ML
Cilleruelo
Sonia
S
Fernández-Fernández
Juana
J
Jiménez-Jiménez
Ana Isabel
AI
Rayo
Carmen Hernando
CH
de Larramendi
D002446:Celiac Disease / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006683:HLA-DQ Antigens / Q000097:blood / Q000235:genetics*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
D006683:HLA-DQ Antigens