Western children have higher rates of subclinical celiac disease

Reuters Health Information: Western children have higher rates of subclinical celiac disease

Western children have higher rates of subclinical celiac disease

Last Updated: 2017-01-30

By David L. Levine

NEW YORK (Reuters Health) - Celiac disease autoimmunity (CDA) - that is, the presence of antibodies against transglutaminase type 2 (TG2A) but no symptoms of the disease - is more common in Western than in non-Western populations, with ethnic differences already obvious in children, according to researchers in the Netherlands.

Using data from the Generation R Study, a prospective multi-ethnic population-based cohort study from early pregnancy onward, the researchers found higher TG2A seroprevalence at age 6 in Western children (Dutch, European, Indonesian, American, Oceanian) that in non-Western children (Turkish, Moroccan, Cape Verdean, Antillean, Surinamese).

Western ethnicity included Dutch, European, American Western (including North American), Asian Western (including Indonesian and Japanese) and Oceanian. Non-Western ethnicity included Turkish, Moroccan, Surinamese, Antillean, Cape Verdean, African, Asian non-Western (all Asian counties except Indonesia and Japan) and American non-Western (including South American and Central American).

In email to Reuters Health, Henriette A. Moll, a member of the Generation R Study Group at Erasmus Medical Center in Rotterdam, said, "Environmental factors play a role in celiac disease. Socioeconomic position, daycare attendance and CMV seropositivity partially explain these differences. The insights that we have obtained with our study may serve as targets for primary and secondary prevention strategies to avoid celiac disease autoimmunity."

As reported online January 4 in Archives of Disease in Childhood, the researchers used data from 4,442 children born between 2002 and 2006, two-thirds of whom were Western. The median age was six years. The Western children were slightly younger and had a slightly lower body mass index. The Western mothers were more highly educated and had a higher family household income than the non-Western mothers. Western children also had a slightly higher birth weight, were less often breastfed and more frequently introduced to gluten before six months of age.

Overall, 60 children (1.4%) were TG2A positive, including 31 who were strongly positive (i.e., TG2A levels at least 70 U/mL). "Western ethnicity was positively associated with TG2A positivity (adjusted odds ratio 1.94; 95% CI 1.02 to 3.70)," the authors reported. "The association was mainly driven by the children who were TG2A strong positive (aOR Western ethnicity 6.85)."

Also, they found, CMV seropositivity was inversely related to strong TG2A positivity (OR 0.32). Together, they report, these factors explained up to 47% of the ethnic differences in TG2A positivity between Western and non-Western children.

Dr. Mark R. Corkins, a spokesperson for the American Academy of Pediatrics and Division Chief of Pediatric Gastroenterology at the University of Tennessee Health Science Center in Memphis, told Reuters Health by telephone, "The CMV relation to celiac disease noted by the researchers is very interesting and is not widely known. I was surprised how strong the correlation was."

The research team summarized the significance of their findings as follows: "Nearly 50% of the ethnic differences in TG2A positivity between Western and non-Western children can be explained by socioeconomic position and lifestyle-related factors. High socioeconomic position and the absence of CMV infection in Western children are associated with increased risk of CD autoimmunity. Variation in socioeconomic position was considered to be the most important explaining factor, followed by CMV infection."

"These factors may serve as targets for primary and secondary prevention strategies" for celiac disease autoimmunity," they conclude.

SOURCE: http://bit.ly/2ik8se1

Arch Dis Child 2017.

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