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Revisiting the risk of celiac disease in children born small for gestational age: A sibling design perspective.

Wingren, Carl Johan LU ; Agardh, Daniel LU and Merlo, Juan LU (2012) In Scandinavian Journal of Gastroenterology 47(6). p.632-639
Abstract
Objective: An association between small for gestational age (SGA) and risk for celiac disease (CD) in childhood has previously been reported. However, this association may reflect residual confounding by genetic or environmental factors. For example, presence of subclinical CD in the mother might be a common cause of both SGA and CD in the offspring. We investigate whether SGA is causally associated with CD before age six years by applying both conventional population-based regression models and sibling analysis that investigates the association in siblings discordant for SGA.



Material and methods: Using the Swedish Medical Birth Registry, we identified all singleton children born in Sweden during 1987-1993 (792,401).... (More)
Objective: An association between small for gestational age (SGA) and risk for celiac disease (CD) in childhood has previously been reported. However, this association may reflect residual confounding by genetic or environmental factors. For example, presence of subclinical CD in the mother might be a common cause of both SGA and CD in the offspring. We investigate whether SGA is causally associated with CD before age six years by applying both conventional population-based regression models and sibling analysis that investigates the association in siblings discordant for SGA.



Material and methods: Using the Swedish Medical Birth Registry, we identified all singleton children born in Sweden during 1987-1993 (792,401). Of these we included 681,954 children in the study and identified 2641 cases of CD using the Swedish National In-Hospital Registry. We applied both conventional Cox regression analysis and a quasi-experimental sibling design that to some extent simulates a counterfactual situation of exposure, reducing possible confounding effects of genetic and shared environmental factors.



Results: We identified an increased risk of CD in both boys (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.25-2.32) and girls (HR 1.30, 95% CI 0.99-1.70) using conventional Cox regression models. Using sibling analysis, the association between SGA and CD was confirmed in boys (HR 4.23, 95% CI 1.19-15.04) but not in girls (HR 1.00, 95% CI 0.45-2.20).



Conclusions: Our results support a causal association between SGA and CD risk in boys but not in girls, although the mechanisms underlying this difference are still unclear. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Gastroenterology
volume
47
issue
6
pages
632 - 639
publisher
Taylor & Francis
external identifiers
  • WOS:000303833600003
  • PMID:22428795
  • Scopus:84860845212
ISSN
1502-7708
DOI
10.3109/00365521.2012.661760
language
English
LU publication?
yes
id
2d40df5d-bbef-4e66-b064-6e4be8eeab6d (old id 2431666)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22428795?dopt=Abstract
date added to LUP
2012-04-03 12:08:41
date last changed
2016-10-13 04:33:23
@misc{2d40df5d-bbef-4e66-b064-6e4be8eeab6d,
  abstract     = {Objective: An association between small for gestational age (SGA) and risk for celiac disease (CD) in childhood has previously been reported. However, this association may reflect residual confounding by genetic or environmental factors. For example, presence of subclinical CD in the mother might be a common cause of both SGA and CD in the offspring. We investigate whether SGA is causally associated with CD before age six years by applying both conventional population-based regression models and sibling analysis that investigates the association in siblings discordant for SGA. <br/><br>
<br/><br>
Material and methods: Using the Swedish Medical Birth Registry, we identified all singleton children born in Sweden during 1987-1993 (792,401). Of these we included 681,954 children in the study and identified 2641 cases of CD using the Swedish National In-Hospital Registry. We applied both conventional Cox regression analysis and a quasi-experimental sibling design that to some extent simulates a counterfactual situation of exposure, reducing possible confounding effects of genetic and shared environmental factors. <br/><br>
<br/><br>
Results: We identified an increased risk of CD in both boys (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.25-2.32) and girls (HR 1.30, 95% CI 0.99-1.70) using conventional Cox regression models. Using sibling analysis, the association between SGA and CD was confirmed in boys (HR 4.23, 95% CI 1.19-15.04) but not in girls (HR 1.00, 95% CI 0.45-2.20). <br/><br>
<br/><br>
Conclusions: Our results support a causal association between SGA and CD risk in boys but not in girls, although the mechanisms underlying this difference are still unclear.},
  author       = {Wingren, Carl Johan and Agardh, Daniel and Merlo, Juan},
  issn         = {1502-7708},
  language     = {eng},
  number       = {6},
  pages        = {632--639},
  publisher    = {ARRAY(0x92aac30)},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Revisiting the risk of celiac disease in children born small for gestational age: A sibling design perspective.},
  url          = {http://dx.doi.org/10.3109/00365521.2012.661760},
  volume       = {47},
  year         = {2012},
}