Lower economic status and inferior hygienic environment may protect against celiac disease

Abstract

Background. The populations in adjacent Russian Karelia and Finland are equally exposed to grain products and share partly the same ancestry, but live in completely different socioeconomic environments.

Aim. This creates an ideal epidemiological setting to study gene‐environmental interactions in pathogenesis of celiac disease.

Methods. The prevalence of celiac disease and predisposing human leukocyte antigen (HLA) alleles was compared between Russian Karelia and Finland. Tissue transglutaminase antibodies and HLA‐DQ alleles were screened from 1988 schoolchildren from Karelia and 3654 children from Finland. Children with transglutaminase antibodies were invited to small‐bowel biopsy.

Results. Transglutaminase antibodies were less frequent in Russian Karelia than in Finland (0.6% versus 1.4%, P = 0.005). Immunoglobulin class G (IgG) antigliadin antibodies were also less frequent in Russian Karelia (10.2% versus 28.3%, P<0.0001). Celiac disease was confirmed by duodenal biopsy in four of the eight transglutaminase antibody‐positive Karelian children, giving a prevalence of 1 in 496 compared to 1 in 107 children in Finland. The same HLA‐DQ alleles were associated with celiac disease and transglutaminase antibody positivity in both populations.

Conclusions. The prevalence of transglutaminase antibodies and celiac disease is lower in Russian Karelia than in Finland. This may be associated with a protective environment characterized by inferior prosperity and standard of hygiene in Karelia.

• Celiac disease
• children
• Finland
• gluten
• HLA
• prevalence
• Russia

Acknowledgements

This study was supported by the EU as a part of the INCO‐Copernicus Programme (EPIVIR study, contract number IC15‐CT98‐0316) and by grants from the Päivikki and Sakari Sohlberg Foundation, the Tampere Tuberculosis Foundation, the Academy of Finland, and the University of Tampere. These funders had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. We thank Eveliina Jalonen, Mervi Kekäläinen, Terttu Lauren, and Ritva Suominen for their skilful technical assistance. We express our gratitude to Dr Elena Kozubova, Dr Oleg Leksunov, and Dr Vladimir Petrov from the Committee on Public Health, Ecology and Social Protection, Petrozavodsk City Administration, for the valuable help and support. We would like to thank Virginia Mattila and Sisko Tauriainen for their suggestions and input in the preparation of this manuscript. We express our gratitude to all children and parents who participated in the study. The authors have no conflict of interest to declare. The principal investigator (HH) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The EPIVIR study group includes: H. Hyöty (coordinator), M. Knip, H. Viskari, University of Tampere, Finland; J. Ilonen, University of Turku, Finland; A. Reunanen, National Public Health Institute, Helsinki, Finland; R. Uibo (scientific coordinator), L. Salur, University of Tartu, Estonia; J. Ludvigsson, University of Linköping, Sweden; D. Marciulionyte, Kaunas University of Medicine, Lithuania; R. Hermann, G. Soltesz, University of Pécs, Hungary; M. Füchtenbusch, A. Ziegler, Munich, Germany; A. Kondrashova, A. Romanov, University of Petrozavodsk, Russia.