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Early life infections associated with increased risk for celiac disease
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A Norwegian population-based study found associations that suggest early life infections may play a role in the later development of celiac disease.
“There are strong indications that environmental factors, other than gluten exposure, significantly influence the development of celiac disease. However, little is known about the nature and timing of such factors,” Karl Mårild, MD, PhD, from the division of epidemiology, Norwegian Institute of Public Health, told Healio Gastroenterology. “Previous studies on early life infections and risk of later celiac disease are inconsistent, but have mostly been limited to retrospective designs, inpatient data or insufficient statistical power.”
Karl Mårild
To evaluate the association between early life infections and the later development of celiac disease, Mårild and colleagues analyzed prospective population-based data as part of the Norwegian Mother and Child Cohort Study. For 72,921 children born between 2000 and 2009, parent-reported infectious disease data was available up to 18 months of age. Celiac disease diagnoses through 2013 were identified via parental questionnaires and the Norwegian Patient Registry. The main analysis of the study was risk for later development of celiac disease associated with overall frequency of infections in the first 18 months of life.
Overall, 0.8% of children developed celiac disease during a median follow-up period of 8.5 years (range, 4.5-14.5 years).
Children with 10 or more infections by the time they turned 18 months old had a significantly greater risk for later development of celiac disease compared with children who had four or fewer infections (adjusted OR = 1.32; 95% CI, 1.06-1.65; per increase in infectious episodes, aOR = 1.03; 95% CI, 1.02-1.05).
The aORs per increase in specific types of infections were 1.03 (95% CI, 1.02-1.05) for upper respiratory tract infections, 1.12 (95% CI, 1.01-1.23) for lower respiratory tract infections and 1.05 (95% CI, 0.99-1.11) for gastroenteritis.
Comparable results were observed after adjusting for potential confounders, including maternal celiac disease, education level, smoking, birth weight, prematurity, infant feeding practices, birth season and antibiotic exposure.
“This study is the first large-scale population-based cohort study of this association and our results may provide better understanding to patients and practitioners on one significant aspect of the likely multifactorial celiac disease etiology,” Mårild said. “Still, it is important to underline that noncausal explanations for this association cannot be excluded and to note that we found overall only modestly increased risk estimates for celiac disease. Thus, our results should not alter the advice on the clinical follow-up of children with high infection frequency.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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