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. 2003 Jan;57(1):36–39. doi: 10.1136/jech.57.1.36

Children born in the summer have increased risk for coeliac disease

A Ivarsson 1, O Hernell 1, L Nystrom 1, L Persson 1
PMCID: PMC1732262  PMID: 12490646

Abstract

Study objective: Coeliac disease, also called permanent gluten sensitive enteropathy, is being recognised as a widespread health problem. Defining the possible role of environmental factors in its aetiology might open doors to primary prevention. This study therefore analysed if the risk for coeliac disease varies with month of birth as a proxy for a seasonal pattern for possible causal environmental exposure(s).

Design: A population based incidence register of coeliac disease in children below 15 years of age covering the period from 1973 to 1997. Incidence rates were calculated by month of birth, stratified for age at diagnosis. Poisson regression analyses were used to estimate the relative risk for coeliac disease for children below 2 years of age by season of birth, also taking into account gender and time period of diagnosis.

Setting: Sweden.

Participants: All 2151 children in the study base with verified coeliac disease.

Main results: The risk for coeliac disease was significantly higher if born during the summer as compared with the winter (RR=1.4, 95% CI 1.2 to 1.7), but only in children below 2 years of age at diagnosis. This relative seasonal risk pattern prevailed during a 10 year epidemic of coeliac disease, although incidence rates varied threefold. The incidence was constantly higher among girls as compared with boys, but boys showed a more pronounced seasonal variation in risk than girls.

Conclusions: An increased coeliac disease risk in children born in the summer compared with the winter reflects causal environmental exposure(s) with a seasonal pattern. Infections might be the exposure of importance, either by means of a direct causal role and/or through interaction with other exposures, for example, gluten intake. However, non-infectious exposures should also be explored as possible contributing causal factors.

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Selected References

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  1. Cronin C. C., Shanahan F. Insulin-dependent diabetes mellitus and coeliac disease. Lancet. 1997 Apr 12;349(9058):1096–1097. doi: 10.1016/S0140-6736(96)09153-2. [DOI] [PubMed] [Google Scholar]
  2. Dahlquist G. G., Ivarsson S., Lindberg B., Forsgren M. Maternal enteroviral infection during pregnancy as a risk factor for childhood IDDM. A population-based case-control study. Diabetes. 1995 Apr;44(4):408–413. doi: 10.2337/diab.44.4.408. [DOI] [PubMed] [Google Scholar]
  3. Dahlquist G., Blom L., Holmgren G., Hägglöf B., Larsson Y., Sterky G., Wall S. The epidemiology of diabetes in Swedish children 0-14 years--a six-year prospective study. Diabetologia. 1985 Nov;28(11):802–808. doi: 10.1007/BF00291068. [DOI] [PubMed] [Google Scholar]
  4. Ginsberg-Fellner F., Witt M. E., Yagihashi S., Dobersen M. J., Taub F., Fedun B., McEvoy R. C., Roman S. H., Davies R. G., Cooper L. Z. Congenital rubella syndrome as a model for type 1 (insulin-dependent) diabetes mellitus: increased prevalence of islet cell surface antibodies. Diabetologia. 1984 Jul;27 (Suppl):87–89. doi: 10.1007/BF00275655. [DOI] [PubMed] [Google Scholar]
  5. Howdle P. D., Blair Zajdel M. E., Smart C. J., Trejdosiewicz L. K., Blair G. E., Losowky M. S. Lack of a serologic response to an E1B protein of adenovirus 12 in coeliac disease. Scand J Gastroenterol. 1989 Apr;24(3):282–286. doi: 10.3109/00365528909093047. [DOI] [PubMed] [Google Scholar]
  6. Hyöty H., Hiltunen M., Knip M., Laakkonen M., Vähäsalo P., Karjalainen J., Koskela P., Roivainen M., Leinikki P., Hovi T. A prospective study of the role of coxsackie B and other enterovirus infections in the pathogenesis of IDDM. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes. 1995 Jun;44(6):652–657. doi: 10.2337/diab.44.6.652. [DOI] [PubMed] [Google Scholar]
  7. Ivarsson A., Persson L. A., Hernell O. Does breast-feeding affect the risk for coeliac disease? Adv Exp Med Biol. 2000;478:139–149. doi: 10.1007/0-306-46830-1_12. [DOI] [PubMed] [Google Scholar]
  8. Ivarsson A., Persson L. A., Nyström L., Ascher H., Cavell B., Danielsson L., Dannaeus A., Lindberg T., Lindquist B., Stenhammar L. Epidemic of coeliac disease in Swedish children. Acta Paediatr. 2000 Feb;89(2):165–171. doi: 10.1080/080352500750028771. [DOI] [PubMed] [Google Scholar]
  9. Jongbloet P. H., Groenewoud H. M., Hirasing R. A., Van Buuren S. Seasonality of birth in patients with childhood diabetes in The Netherlands. Diabetes Care. 1998 Jan;21(1):190–191. doi: 10.2337/diacare.21.1.190. [DOI] [PubMed] [Google Scholar]
  10. Kagnoff M. F., Paterson Y. J., Kumar P. J., Kasarda D. D., Carbone F. R., Unsworth D. J., Austin R. K. Evidence for the role of a human intestinal adenovirus in the pathogenesis of coeliac disease. Gut. 1987 Aug;28(8):995–1001. doi: 10.1136/gut.28.8.995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Leslie R. D., Elliott R. B. Early environmental events as a cause of IDDM. Evidence and implications. Diabetes. 1994 Jul;43(7):843–850. doi: 10.2337/diab.43.7.843. [DOI] [PubMed] [Google Scholar]
  12. Lévy-Marchal C., Patterson C., Green A. Variation by age group and seasonality at diagnosis of childhood IDDM in Europe. The EURODIAB ACE Study Group. Diabetologia. 1995 Jul;38(7):823–830. doi: 10.1007/s001250050359. [DOI] [PubMed] [Google Scholar]
  13. Murray J. A. The widening spectrum of celiac disease. Am J Clin Nutr. 1999 Mar;69(3):354–365. doi: 10.1093/ajcn/69.3.354. [DOI] [PubMed] [Google Scholar]
  14. Mäki M., Collin P. Coeliac disease. Lancet. 1997 Jun 14;349(9067):1755–1759. doi: 10.1016/S0140-6736(96)70237-4. [DOI] [PubMed] [Google Scholar]
  15. Rothwell P. M., Gutnikov S. A., McKinney P. A., Schober E., Ionescu-Tirgoviste C., Neu A. Seasonality of birth in children with diabetes in Europe: multicentre cohort study. European Diabetes Study Group. BMJ. 1999 Oct 2;319(7214):887–888. doi: 10.1136/bmj.319.7214.887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Schuppan D. Current concepts of celiac disease pathogenesis. Gastroenterology. 2000 Jul;119(1):234–242. doi: 10.1053/gast.2000.8521. [DOI] [PubMed] [Google Scholar]
  17. Sollid L. M. Molecular basis of celiac disease. Annu Rev Immunol. 2000;18:53–81. doi: 10.1146/annurev.immunol.18.1.53. [DOI] [PubMed] [Google Scholar]
  18. Whitacre C. C., Reingold S. C., O'Looney P. A. A gender gap in autoimmunity. Science. 1999 Feb 26;283(5406):1277–1278. doi: 10.1126/science.283.5406.1277. [DOI] [PubMed] [Google Scholar]

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