The incidence of new celiacdisease with onset by age 10 appears to be rising and varies widely by region, suggesting different environmental, genetic, and epigenetic influences within the U.S., according to a new report.
The Environmental Determinants of Diabetes in the Young study prospectively follows children born between 2004 and 2010 who are at genetic risk for bothand CD at six clinical sites in four countries: the United States, Finland, Germany, and Sweden. In the United States, patients are enrolled in Colorado, Georgia, and Washington.
Blood samples were obtained and stored every 3 months until age 48 months and at least every 6 months after that. At age 2, participants were screened annually for tTGA. With the first tTGA positive result, all prior collected samples from the patient were tested for tTGA to determine the earliest time point of autoimmunity.
As of July 2020, among the children who had undergone one or more tTGA tests, 6628 HLA-typed eligible children were found to carry the DQ2.5, the D8.1, or both haplogenotypes and were included in the analysis. The median follow-up period was 11.5 years. Overall, the 10-year cumulative incidence was highest in Sweden, at 8.4% for CDA and 3% for CD. Within the United States, Colorado had the highest cumulative incidence for both endpoints, at 6.5% for CDA and 2.4% for CD. Washington had the lowest incidence across all sites, at 4.6% for CDA and 0.9% for CD.
The research team performed a post hoc sensitivity analysis using a lower tTGA cutoff to reduce bias in site differences for biopsy referral and to increase sensitivity of the CD definition for incidence estimation. When the tTGA cutoff was lowered to an average two-visit tTGA of 67.4 or higher, more children met the serologic criteria for CD.
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