More enterovirus infections in early childhood bumps celiac disease risk

  • BMJ

  • de Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Having more enterovirus infections in early childhood increases risk for celiac disease.
  • Adenovirus infections do not show this association.

Why this matters

  • Gut infections in childhood could compromise the mucosal barrier and allow antigen transfer.
  • Another study implicated rotavirus infection in celiac risk.
  • Retrospective studies on enteroviruses and adenoviruses have yielded mixed findings.

Key results

  • Enterovirus was more common in children who then developed celiac disease antibodies:
    • aOR, 1.49 (95% CI, 1.07-2.06; P=.02).
  • Samples with more virus (>100,000 copies/μL), more infectious episodes, or from chronic infection (>2 months) were linked to higher risk, with respective aORs (95% CIs):
    • 2.11 (1.24-3.60; P=.01); 
    • 1.27 (0.87-1.86; P=.21); and
    • 2.16 (1.16-4.04; P=.02).
  • Enteroviruses A (P=.03) and B (P=.003) were linked to celiac risk, but C and D were not.
  • Adenoviruses showed no association.

Study design

  • Nested case-control study, Norwegian birth cohort 2001-2007.
  • Children with celiac risk variant matched to controls.
  • Stool samples analyzed for ages 3-36 months.
  • Celiac antibodies assessed at 3, 6, 9, 12 months, then annually.
  • Funding: Research Council of Norway; Norwegian Coeliac Society; others.

Limitations

  • 10-year (or less) follow-up might have been too short to detect all celiac cases.
  • Type 1 diabetes was original study focus.