Fewer celiac diagnoses among poor UK children

By Andrew M. Seaman (Reuters Health) – Children from poorer areas in the UK are less likely to be diagnosed with celiac disease - but it's not clear why, researchers say. “We really don’t have any information from this piece of research to say why there are differences" between children from relatively poor areas compared to those from the least deprived areas, said Laila Tata, the study’s senior author from the University of Nottingham in the UK. Her team found roughly one new diagnosis of celiac disease for every 7,000 children living in wealthy areas, compared to about one new diagnosis for every 12,800 children living in the most deprived areas. In celiac disease, the immune system reacts to gluten, a protein found in wheat, barley and rye. Eating foods with gluten damages the small intestine and keeps it from absorbing nutrients. Tata and colleagues think the likeliest explanation for their findings is that in poorer areas, children's celiac disease is – for some reason – less likely to be noticed by doctors. As reported in the journal Archives of Childhood Diseases, the researchers analyzed medical records from a nationally representative sample of UK children and teens, who visited doctors between 1993 and 2012. Overall, there was about one new diagnosis of celiac disease for every 10,000 children per year, with diagnoses more common among girls. The incidence of celiac disease increased over time, which is what other researchers have reported from other countries. For example, the overall incidence of new cases increased from about one per 12,048 children between 1993 and 1997, to one per 6,897 children between 2008 and 2012. While the rate of diagnosis among children younger than two years remained stable, the rate almost tripled among those ages two to 18. Patterns have been "very similar across the world,” said Dr. Stefano Guandalini, medical director of the University of Chicago Celiac Disease Center. As for the finding that poorer children were less likely to be diagnosed with celiac disease, he said the odds of a diagnosis may be lower, but it may also be that – for some reason – children from poorer areas are somehow protected. Guandalini, who was not involved with the new study, said researchers have suspected that breastfeeding and the timing of introduction of gluten to babies' diets played a role in the risk of developing celiac disease. Recent studies have not supported that theory, however - including one published earlier this week (see Reuters Health story of January 19, 2015 here: http://reut.rs/1y9APs6.) “We still really don’t know the reason, to be honest,” Guandalini said. “There are other factors that people have been looking at.” Those include infections early in childhood and the use of antibiotics. “We will probably not know a clear answer to these questions for five to 10 years, but studies are there and people are working toward it,” he said. In the meantime, Guandalini said, people should not start a gluten-free diet until they’ve been checked for celiac disease. “You cannot make a self diagnosis" just on the basis of feeling better by avoiding gluten, he said. SOURCE: http://bit.ly/1yE2oP3 Archives of Childhood Diseases, online January 22, 2015.