Younger Age at Onset and Sex Predict Celiac Disease in Children and Adolescents With Type 1 Diabetes

An Italian multicenter study

  1. Franco Cerutti, MD1,
  2. Graziella Bruno, MD2,
  3. Francesco Chiarelli, MD3,
  4. Renata Lorini, MD4,
  5. Franco Meschi, MD5,
  6. Carla Sacchetti, MD1 and
  7. the Diabetes Study Group of Italian Society of Pediatric Endocrinology and Diabetology*
  1. 1Department of Pediatrics, University of Torino, Torino, Italy
  2. 2Department of Internal Medicine, University of Torino, Torino, Italy
  3. 3Department of Pediatrics, University of Chieti, Chieti, Italy
  4. 4Department of Pediatrics, University of Genova, G. Gaslini Institute, Genova, Italy
  5. 5Department of Pediatrics, University of Milano, Vita-Salute H.S. Raffaele, Milano, Italy
  1. Address correspondence and reprint requests to Dr. Franco Cerutti, Dipartimento di Scienze Pediatriche e dell’Adolescenza, Università di Torino, Piazza Polonia 94, I-10126, Torino, Italy. E-mail: franco.cerutti{at}unito.it

Abstract

OBJECTIVE—To estimate the prevalence of biopsy-confirmed celiac disease in Italian children and adolescents with type 1 diabetes and to assess whether age at onset of type 1 diabetes is independently associated with diagnosis of celiac disease.

RESEARCH DESIGN AND METHODS—The study group was a clinic-based cohort of children and adolescents with type 1 diabetes cared for in 25 Italian centers for childhood diabetes. Yearly screening for celiac disease was performed using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies.

RESULTS—Of the 4,322 children and adolescents (age 11.8 ± 4.2 years) identified with type 1 diabetes, biopsy-confirmed celiac disease was diagnosed in 292 (prevalence 6.8%, 95% confidence interval [CI] 6.0–7.6), with a higher risk seen in girls than in boys (odds ratio [OR] 1.93, 1.51–2.47). In 89% of these, diabetes was diagnosed before celiac disease. In logistic regression analyses, being younger at onset of diabetes, being female, and having a diagnosis of a thyroid disorder were independently associated with the risk of having diabetes and celiac disease. In comparison with subjects who were older than 9 years at onset of diabetes, subjects who were younger than 4 years at onset had an OR of 3.27 (2.20–4.85).

CONCLUSIONS—We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age <4 years than in those age >9 years; and 3) girls have a higher risk of having both diseases than boys.

Footnotes

  • *

    * Members of the Diabetes Study Group of Italian Society of Pediatric Endocrinology and Diabetology are listed in the appendix.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted March 8, 2004.
    • Received August 13, 2003.
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