title: Large population study shows that adolescents with celiac disease have an increased risk of multiple autoimmune and nonautoimmune comorbidities.
abstract: OBJECTIVE
  Celiac disease (CD) is a systemic disorder that is associated with various autoimmune disorders and a higher prevalence of other diagnoses and complications. This large, cross-sectional, population-based study investigated the associations between CD and various medical conditions during late adolescence.
  
  
  METHODS
  We included 2 001 353 Jewish Israeli adolescents who underwent a general health examination at a median age of 17.1 (16.9-17.4) years from 1988 to 2015. Comprehensive data regarding medical status were available for 1 588 041 (79%) subjects. A definite diagnosis of CD was based on accepted criteria. Covariate data included demographic measures and data on associated medical conditions.
  
  
  RESULTS
  Overall, data on 7145 subjects with CD and 1 580 896 controls were analysed. Multivariate analyses showed that autoimmune diseases were significantly more common in subjects with CD, including insulin dependent diabetes, with an odds ratio (OR) of 5.5, inflammatory bowel diseases (OR = 3.8), arthritis (OR = 2.4), thyroid diseases (OR = 1.8) and psoriatic skin disorders (OR = 1.6). Further associations included asthma (OR = 1.5), bile stones (OR = 3.6), migraine (OR = 2.3), anaemia (OR = 1.7) and menstrual abnormalities (OR = 1.5). Long bone fractures and axial fractures were no more common in adolescents with CD than controls.
  
  
  CONCLUSIONS
  CD was already associated with multiple comorbidities by adolescence, and these were not limited to autoimmune disorders.
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Assa
authors.affiliation: Medical Corps, Israel Defense Forces, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Frenkel-Nir
authors.affiliation: Medical Corps, Israel Defense Forces, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Medical Corps, Israel Defense Forces, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Lior H
authors.initials: LH
authors.lastname: Katz
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male
keywords: Adolescence; Autoimmune disorders; Celiac disease; Comorbidities; Diabetes