title: Exploring the risk factors for differences in the cumulative incidence of coeliac disease in two neighboring countries: the prospective DIABIMMUNE study.
abstract: BACKGROUND
  During the last several decades the prevalence of coeliac disease (CD) has increased worldwide.
  
  
  OBJECTIVE
  To compare the cumulative incidence of CD between Estonian and Finnish children and to identify the risk factors.
  
  
  METHODS
  Children were recruited as part of the DIABIMMUNE Study. In the birth cohort (BC) 258 children from Estonia and 305 from Finland, and in the young children's cohort (YCC) 1363 and 1384 children were followed up, respectively. The diagnosis of CD was made in accordance with the ESPGHAN guidelines-the presence of IgA-tTG antibodies and small bowel villous atrophy.
  
  
  RESULTS
  During the study period 29 children developed CD. The cumulative incidence of CD was significantly higher in Finland (0.77% vs 0.27%; P=0.01). No difference was seen between the children with CD and the controls in the duration of breastfeeding or the age at cereal introduction. The BC children with CD had had significantly more episodes of infections with fever by the age of 12 months compared to the controls (3.4 vs 1.4; P=0.04).
  
  
  CONCLUSIONS
  The 5-year cumulative incidence of childhood CD is significantly higher in Finland than in Estonia. Sequential infections early in life may increase the risk for developing CD.
authors: Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia; Children's Clinic of Tartu University Hospital, Tartu, Estonia.
authors: Kärt
authors: K
authors: Simre
authors: Children's Clinic of Tartu University Hospital, Tartu, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia.
authors: Oivi
authors: O
authors: Uibo
authors: Children's Clinic of Tartu University Hospital, Tartu, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia.
authors: Aleksandr
authors: A
authors: Peet
authors: Children's Clinic of Tartu University Hospital, Tartu, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia.
authors: Vallo
authors: V
authors: Tillmann
authors: Department of Pediatrics, University of Tartu, Tartu, Estonia.
authors: Pille
authors: P
authors: Kool
authors: Jorvi Hospital, Helsinki University Hospital, Espoo, Finland.
authors: Anu-Maaria
authors: AM
authors: Hämäläinen
authors: Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors: Taina
authors: T
authors: Härkönen
authors: Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors: Heli
authors: H
authors: Siljander
authors: Nutrition Unit, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland; Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland.
authors: Suvi
authors: S
authors: Virtanen
authors: Immunogenetics Laboratory, University of Turku and Turku University Hospital, Turku, Finland.
authors: Jorma
authors: J
authors: Ilonen
authors: Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland; Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland; Folkhälsan Research Center, Helsinki, Finland.
authors: Mikael
authors: M
authors: Knip
authors: Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia. Electronic address: raivo.uibo@ut.ee.
authors: Raivo
authors: R
authors: Uibo
mesh_terms: D001942:Breast Feeding; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology*; D002675:Child, Preschool; D004957:Estonia / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D011503:Transglutaminases / Q000276:immunology*; D014611:Vaccination
chemical_list: D007070:Immunoglobulin A; D011503:Transglutaminases
keywords: Breastfeeding; Coeliac disease; Early feeding; Early infections