title: Ethnic differences in coeliac disease autoimmunity in childhood: the Generation R Study.
abstract: The aim was to identify whether ethnic differences in coeliac disease autoimmunity (CDA) in children at 6 years of age exist, and when present, to evaluate how these differences may be explained by sociodemographic and environmental factors.
  
  
  
  This study was embedded within a multi-ethnic population-based prospective cohort study.
  
  
  
  4442 six-year-old children born between 2002 and 2006 were included. Information on ethnicity, environmental and lifestyle characteristics was assessed by questionnaires. Ethnicity was categorised into Western (Dutch, European, Indonesian, American, Oceanian) and non-Western (Turkish, Moroccan, Cape Verdean, Antillean, Surinamese). Serum transglutaminase type 2 antibody (TG2A) levels were measured with fluorescence enzyme immunoassay. Serum IgG levels against cytomegalovirus (CMV) were measured by ELISA.
  
  
  
  TG2A positivity was defined as TG2A ≥7 U/mL, strong TG2A positivity as TG2A ≥10 upper limit normal (70 U/mL).
  
  
  
  Of 4442 children, 60 (1.4%) children were TG2A positive, of whom 31 were strong positive. 66% of children were Western, 33% non-Western. Western ethnicity, high socioeconomic position and daycare attendance were positively associated with strong TG2A positivity (odds ratio (OR) 6.85 (1.62 to 28.8) p<0.01, OR 3.70 (1.40 to 9.82) p<0.01, OR 3.90 (1.38 to 11.0) p=0.01 resp.), whereas CMV seropositivity was inversely related to strong TG2A positivity (OR 0.32 (0.12 to 0.84) p=0.02). Together, these factors explained up to 47% (-67 to -17; p=0.02) of the ethnic differences in TG2A positivity between Western and non-Western children.
  
  
  
  Ethnic differences in children with CDA are present in childhood. Socioeconomic position, daycare attendance and CMV seropositivity partly explained these differences, which may serve as targets for prevention strategies for CDA.
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Michelle A E
authors.initials: MAE
authors.lastname: Jansen
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Sytske A
authors.initials: SA
authors.lastname: Beth
authors.affiliation: Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Diana
authors.initials: D
authors.lastname: van den Heuvel
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Global Public Health, Leiden University College, The Hague, The Netherlands.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Kiefte-de Jong
authors.affiliation: Department of Public Health, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Vincent W V
authors.initials: VWV
authors.lastname: Jaddoe
authors.affiliation: Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia.
authors.forename: Menno C
authors.initials: MC
authors.lastname: van Zelm
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Moll
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000208:ethnology* / Q000276:immunology; D015551:Autoimmunity; D002446:Celiac Disease / Q000208:ethnology* / Q000276:immunology; D002648:Child; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008019:Life Style; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012923:Social Class; D012959:Socioeconomic Factors; D011503:Transglutaminases / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D001323:Autoantibodies; D007074:Immunoglobulin G; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Celiac disease; Cohort study; Cytomegalovirus; Ethnicity; Pediatric