Epidemic of coeliac disease in Swedish children

Coeliac disease has emerged as a public health problem. The aim of the pres ent study was to analyse trends in the occurrence of symptomatic coeliac di sease in Swedish children from 1973 to 1997, and to explore any temporal re lationship to changes in infant dietary patterns. We established a populati on-based prospective incidence register of coeliac disease in 1991, and, in addition, retrospective data from 1973 were collected. A total of 2151 cas es fulfilled the diagnostic criteria. Furthermore, we collected national da ta on;I yearly basis on duration of breastfeeding, intake of gluten-contain ing cereals and recommendations on when and how to introduce gluten into th e diet of infants. From 1985 to 1987 the annual incidence rate in children below 2 y of age increased fourfold to 200-240 cases per 100 000 person yea rs, followed from 1995 by a sharp decline to the previous level of 50-60 ca ses per 100 000 person years. This epidemic pattern is quite unique for a c hronic disease of immunological pathogenesis, suggesting that prevention co uld be possible. The ecological observations made in this study are compati ble with the epidemic being the result, at least in part, of a change in an d an interplay among three factors within the area of infant feeding, i.e. amount of gluten given, age at introduction of gluten, and whether breastfe eding was ongoing or not when gluten was introduced. Other factor(s) may al so have contributed, and the search for these should be intensified.