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A Nationwide Study of the Association Between Celiac Disease and the Risk of Autistic Spectrum Disorders
Orebro University Hospital. Karolinska Univ Hosp, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Orebro Univ Hosp, Dept Pediat, S-70185 Orebro, Sweden.;Mayo Clin, Coll Med, Dept Med, Div Gastroenterol & Hepatol, Rochester, MN USA..
Kings Coll London, Inst Psychiat, Dept Psychosis Studies, London WC2R 2LS, England.;Mt Sinai Sch Med, Dept Psychiat, New York, NY USA..
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
Mayo Clin, Coll Med, Dept Med, Div Gastroenterol & Hepatol, Rochester, MN USA..
2013 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 70, no 11, 1224-1230 p.Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Most case reports suggest an association between autistic spectrum disorders (ASDs) and celiac disease (CD) or positive CD serologic test results, but larger studies are contradictory. OBJECTIVE To examine the association between ASDs and CD according to small intestinal histopathologic findings. DESIGN AND SETTING Nationwide case-control study in Sweden. MAIN OUTCOMES AND MEASURES Through 28 Swedish biopsy registers, we collected data about 26 995 individuals with CD(equal to villous atrophy, Marsh stage 3), 12 304 individuals with inflammation (Marsh stages 1-2), and 3719 individuals with normal mucosa (Marsh stage 0) but positive CD serologic test results (IgA/IgG gliadin, endomysium, or tissue transglutaminase) and compared them with 213 208 age-and sex-matched controls. Conditional logistic regression estimated odds ratios (ORs) for having a prior diagnosis of an ASD according to the Swedish National Patient Register. In another analysis, we used the Cox proportional hazards regression model to estimate hazard ratios (HRs) for future ASDs in individuals undergoing small intestinal biopsy. RESULTS A prior ASD was not associated with CD (OR, 0.93; 95% CI, 0.51-1.68) or inflammation (OR 1.03; 95% CI, 0.40-2.64) but was associated with a markedly increased risk of having a normal mucosa but a positive CD serologic test result (OR, 4.57; 95% CI, 1.58-13.22). Restricting our data to individuals without a diagnosis of an ASD at the time of biopsy, CD (HR, 1.39; 95% CI, 1.13-1.71) and inflammation (HR, 2.01; 95% CI, 1.29-3.13) were both associated with moderate excess risks of later ASDs, whereas the HR for later ASDs in individuals with normal mucosa but positive CD serologic test results was 3.09 (95% CI, 1.99-4.80). CONCLUSIONS AND RELEVANCE Although this study found no association between CD or inflammation and earlier ASDs, there was a markedly increased risk of ASDs in individuals with normal mucosa but a positive CD serologic test result.

Place, publisher, year, edition, pages
2013. Vol. 70, no 11, 1224-1230 p.
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-56622DOI: 10.1001/jamapsychiatry.2013.2048ISI: 000328948700015PubMedID: 24068245OAI: oai:DiVA.org:oru-56622DiVA: diva2:1083350
Available from: 2017-03-21 Created: 2017-03-21 Last updated: 2017-03-21Bibliographically approved

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CiteExportLink to record
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