A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders

Jonas F. Ludvigsson, Abraham Reichenberg, Christina M. Hultman, Joseph A Murray

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1224-1230
Number of pages7
JournalJAMA Psychiatry
Volume70
Issue number11
DOIs
StatePublished - 2013

Fingerprint

Celiac Disease
Autistic Disorder
Serologic Tests
Wetlands
Mucous Membrane
Odds Ratio
Inflammation
Biopsy
Gliadin
Proportional Hazards Models
Sweden
Immunoglobulin A
Atrophy
Case-Control Studies
Immunoglobulin G
Logistic Models

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders. / Ludvigsson, Jonas F.; Reichenberg, Abraham; Hultman, Christina M.; Murray, Joseph A.

In: JAMA Psychiatry, Vol. 70, No. 11, 2013, p. 1224-1230.

Research output: Contribution to journalArticle

Ludvigsson, Jonas F. ; Reichenberg, Abraham ; Hultman, Christina M. ; Murray, Joseph A. / A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders. In: JAMA Psychiatry. 2013 ; Vol. 70, No. 11. pp. 1224-1230.
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abstract = "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.",
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