Clinical Aspects of Screening Detected Celiac Disease among 12-year-olds

Sammanfattning: Abstract Sweden experienced an epidemic (1984-96) of celiac disease in children, partly attributed to changes in infant feed- ing. Our aim was to compare the total prevalence of celiac disease in two birth cohorts of 12-year-olds and relate the findings to each cohort’s ascertained infant feeding. Furthermore, we compared the growth parameters in the children with screening-detected celiac disease with their healthy peers. We also investigated the association of thyroid auto- immunity and thyroid function in the celiac disease cases (treated and untreated) compared to the children without celiac disease. In order to study these questions, a two-phase, epidemic and post-epidemic, cross-sectional screening study was per- formed. All celiac disease cases, previously diagnosed and screening-detected, were identified. Infant feeding practices were ascertained. Weight, height and BMI were measured and cut-off points recommended by the International Obesity Task Force, used. A case-control study was designed to investigate thyroid autoimmunity (assessed with antibodies against thyroid peroxidase, TPO Abs) and thyroid function (assessed with thyroid stimulating hormone, TSH, and free thyroxine, fT4). We found a significant difference in prevalence of celiac disease, 2.9% vs. 2.2%, 1993 vs. 1997 cohorts, respectively. The cohorts differed in infant feeding. Screening-detected celiac disease children weighed less and were shorter than their peers. Median BMI was slightly lower. Still, there was no association between being underweight and the risk of having undiagnosed celiac disease and 14% was overweight. Among the previously diagnosed celiac disease cases, 7.5% were TPOAb positive and among screening-detected cases, 7.0%, compared to 2.8% of the controls. Hypo- thyroidism was more common in children with celiac disease and TPO Abs positivity than in children without celiac disease but with TPO Abs. Positive TPO Abs titer increased the risk of developing hypothyroidism in all groups. In conclusion, to gradually introduce gluten-containing foods from four months of age, preferably during ongoing breastfeeding, seems favorable. Growth parameters are slightly affected in children with screening-detected celiac disease but not reliable in predicting celiac disease. Even if well treated, celiacs have a higher prevalence of thyroid autoimmunity than their healthy peers. Having TPO Abs in addition to celiac disease, increases the risk of thyroid dysfunction.