Elsevier

The Journal of Pediatrics

Volume 143, Issue 3, September 2003, Pages 308-314
The Journal of Pediatrics

A prospective study of the incidence of childhood celiac disease

https://doi.org/10.1067/S0022-3476(03)00282-8Get rights and content

Abstract

Objectives

To estimate the frequency of celiac disease (CD) in children in the general population of Denver, Colorado.

Study design

From 22,346 newborns characterized as expressing 0, 1, or 2 HLA-DR3(DQB10201) alleles, 987 were selected for a prospective stratified cohort study. Participants were followed for as long as 7 years with serial testing for serum IgA anti-transglutaminase antibodies and for evidence of CD (intestinal mucosal changes or persistent seropositivity).

Results

Of 40 children with at least one positive serologic test, 19 had evidence of CD (10 by biopsy, 9 by persistent seropositivity). Those expressing 0, 1, or 2 HLA-DR3 alleles had, respectively, 0.3% (95% CI, 0.0-2.7), 3.4% (3.0-11.7), and 3.2% (1.0-11.0) risk for evidence of CD by age 5 years. The adjusted risk estimate for evidence of CD by age 5 years for the Denver general population was 0.9% (0.4-2.0), or 1 in 104 (1:49-221). After adjusting for number of HLA-DR3 alleles expressed, risk was higher in females: RR = 3.34 (1.00-10.9, P = .048). Evidence of CD was not observed before age 2.6 years.

Conclusions

Celiac disease may affect 0.9% of Denver children by 5 years of age. Children positive for the HLA-DR3 allele and females appear to be at increased risk.

Section snippets

Study Population

From December 1993 to September 1999, 22,346 newborns in Denver, Colorado underwent cord blood screening for HLA genotypes associated with CD and type 1 diabetes.13 Of all eligible children born at the St Joseph's Hospital in Denver, Colorado, 85% of parents provided informed consent for HLA screening. The newborn population of this hospital was chosen because it was representative of the general population of the Denver metropolitan area and included children classified by their mothers as

Results

Between December 1993 and September 1999, we determined the HLA-DR genotypes of 22,346 newborns. Parents of 1234 of these newborns were invited and agreed to participate in the prospective follow-up. Of these, 987 infants from 923 families have completed at least one year and 386 (40%) completed at least five years of the follow-up. TG autoantibody results for a representative participant are shown in Figure 1. Overall, 40 children have tested positive for TG autoantibody on at least one

Discussion

This study estimates that at 5 years of age, about 1% of Denver-area children have evidence of CD. This is an estimate of the minimal frequency of CD during childhood because more children may develop autoantibodies during continued follow-up and some TG autoantibody-positive children may undergo repeat small intestine biopsy demonstrating a change from normal to histologic features consistent with CD. In addition, our study design of monitoring the group expressing HLA-DR3 may miss those

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    Supported by NIH grants DK R01-DK50979, DK 32493, DK32083, M01RR00069, General Clinical Research Centers Program, National Center for Research Resources, Autoimmunity Center of Excellence Grant U19AI46374, Diabetes Endocrine Research Center P3057516. None of the authors have any potential, perceived, or real conflict of interest, especially any financial arrangements with a company mentioned in this manuscript.

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