Webb Charlotta, Myléus Anna, Norström Fredrik, Hammarroth Solveig, Högberg Lotta, Lagerqvist Carina, Rosén Anna, Sandström Olof, Stenhammar Lars, Ivarsson Anneli, Carlsson Annelie
*Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund †Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå ‡Pediatric Clinic, Norrtälje Hospital, Norrtälje §Department of Clinical and Experimental Medicine, Pediatrics, Faculty of Health Sciences, Linköping University, Pediatrics in Norrköping, Norrköping ¶Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
J Pediatr Gastroenterol Nutr. 2015 Jan;60(1):54-9. doi: 10.1097/MPG.0000000000000571.
The aim of the study was to evaluate the gluten-free diet (GFD) adherence after 1 year of follow-up in children with screening-detected celiac disease (CD) in a general population.
A total of 18,325 twelve-year-olds were invited to participate in a population-based CD screening (Exploring the Iceberg of Celiacs in Sweden), of whom 13,279 participated. In 240 children, CD was detected through elevated anti-tissue transglutaminase antibodies 2 (TG2-IgA) and verified by a small-intestinal biopsy. This substudy included 210 children with TG2-IgA, evaluated both at the initial biopsy occasion and at 1-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n = 193).
After 1 year, 85% (179/210) had normalized TG2-IgA levels (<5 U/mL). Among those who had >50 U/mL at diagnosis, 25% (16/63) still had elevated TG2-IgA, but for the majority their initial values were more than halved. Most reported a high level of GFD adherence ("always" 82% [158/193] and "often" 16% [30/193]), and 75% [145/193] reported always adhering combined with normalized TG2-IgA. Although reporting that they were always adherent, 13 (6.7%) had not yet normalized their TG2-IgA levels completely; however, a majority of these initially had the highest TG2-IgA levels.
GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12-year-olds. Almost all of them had normalized serology and reported GFD adherence at the 1-year follow-up. A few adolescents who reported GFD adherence, however, had elevated TG2-IgA levels, suggesting more severe disease and/or nonadherence.
本研究旨在评估普通人群中经筛查发现患有乳糜泻（CD）的儿童在随访1年后对无麸质饮食（GFD）的依从性。
共有18325名12岁儿童被邀请参加一项基于人群的CD筛查（瑞典乳糜泻冰山探索研究），其中13279名儿童参与。在240名儿童中，通过抗组织转谷氨酰胺酶抗体2（TG2-IgA）升高检测出CD，并经小肠活检确诊。本亚研究纳入了210名TG2-IgA检测呈阳性的儿童，在初次活检时及随访1年时均进行了评估。通过TG2-IgA测量和自我报告的依从性相结合的方式评估GFD依从性（n = 193）。
1年后，85%（179/210）的儿童TG2-IgA水平恢复正常（<5 U/mL）。在诊断时TG2-IgA水平>50 U/mL的儿童中，25%（16/63）的TG2-IgA水平仍升高，但大多数儿童的初始值下降了一半以上。大多数儿童报告对GFD的依从性较高（“总是”82% [158/193]，“经常”16% [30/193]），75% [145/193]的儿童报告始终坚持GFD且TG2-IgA水平恢复正常。尽管报告始终坚持GFD，但仍有13名（6.7%）儿童的TG2-IgA水平尚未完全恢复正常；然而，这些儿童中的大多数最初的TG2-IgA水平是最高的。
在对瑞典12岁普通人群进行筛查发现患有CD的青少年中，GFD依从性较高。在随访1年时，几乎所有青少年的血清学指标均恢复正常，并报告坚持GFD。然而，少数报告坚持GFD的青少年TG2-IgA水平升高，提示病情更严重和/或存在不依从情况。
