Association Between Antibiotics in the First Year of Life and Celiac Disease

Stine Dydensborg Sander, Anne-Marie Nybo Andersen, Joseph A Murray, Øystein Karlstad, Steffen Husby, Ketil Størdal

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background & Aims: The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics—especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease. Methods: We performed an observational nationwide register-based cohort study. We included all children born in Denmark from 1995 through 2012 or Norway from 2004 through 2012. Children born in Denmark were followed until May 8, 2015 (age at end of follow-up was 2.3–20.3 years) and children born in Norway were followed until December 31, 2013 (age at end of follow-up was 1–10 years). We collected medical information from more than 1.7 million children, including 3346 with a diagnosis of celiac disease. Exposure to systemic antibiotics was defined as a dispensed systemic antibiotic in the first year of life. Results: Exposure to systemic antibiotics in the first year of life was positively associated with diagnosed celiac disease in the Danish and Norwegian cohorts (pooled odds ratio 1.26, 95% confidence interval 1.16–1.36). We found a dose-dependent relation between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic 1.08, 95% confidence interval 1.05–1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts decreased the association slightly (pooled odds ratio 1.18, 95% confidence interval 0.98–1.39). Conclusion: In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics could be a risk factor for celiac disease.

OriginalsprogEngelsk
TidsskriftGastroenterology
Vol/bind156
Udgave nummer8
Sider (fra-til)2217-2229
ISSN0016-5085
DOI
StatusUdgivet - jun. 2019

Fingeraftryk

Celiac Disease
Denmark
Norway
Odds Ratio
Confidence Intervals
Glutens
Delayed Diagnosis
Cohort Studies

Citer dette

Sander, Stine Dydensborg ; Nybo Andersen, Anne-Marie ; Murray, Joseph A ; Karlstad, Øystein ; Husby, Steffen ; Størdal, Ketil. / Association Between Antibiotics in the First Year of Life and Celiac Disease. I: Gastroenterology. 2019 ; Bind 156, Nr. 8. s. 2217-2229.
@article{178da4f8d32d4cd1a3e54e702b099ac9,
title = "Association Between Antibiotics in the First Year of Life and Celiac Disease",
abstract = "Background & Aims: The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics—especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease. Methods: We performed an observational nationwide register-based cohort study. We included all children born in Denmark from 1995 through 2012 or Norway from 2004 through 2012. Children born in Denmark were followed until May 8, 2015 (age at end of follow-up was 2.3–20.3 years) and children born in Norway were followed until December 31, 2013 (age at end of follow-up was 1–10 years). We collected medical information from more than 1.7 million children, including 3346 with a diagnosis of celiac disease. Exposure to systemic antibiotics was defined as a dispensed systemic antibiotic in the first year of life. Results: Exposure to systemic antibiotics in the first year of life was positively associated with diagnosed celiac disease in the Danish and Norwegian cohorts (pooled odds ratio 1.26, 95{\%} confidence interval 1.16–1.36). We found a dose-dependent relation between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic 1.08, 95{\%} confidence interval 1.05–1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts decreased the association slightly (pooled odds ratio 1.18, 95{\%} confidence interval 0.98–1.39). Conclusion: In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics could be a risk factor for celiac disease.",
keywords = "Autoimmunity, Epidemiology, Microbiome, Population",
author = "Sander, {Stine Dydensborg} and {Nybo Andersen}, Anne-Marie and Murray, {Joseph A} and {\O}ystein Karlstad and Steffen Husby and Ketil St{\o}rdal",
note = "Copyright {\circledC} 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "6",
doi = "10.1053/j.gastro.2019.02.039",
language = "English",
volume = "156",
pages = "2217--2229",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "Heinemann",
number = "8",

}

Association Between Antibiotics in the First Year of Life and Celiac Disease. / Sander, Stine Dydensborg; Nybo Andersen, Anne-Marie; Murray, Joseph A; Karlstad, Øystein; Husby, Steffen; Størdal, Ketil.

I: Gastroenterology, Bind 156, Nr. 8, 06.2019, s. 2217-2229.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Association Between Antibiotics in the First Year of Life and Celiac Disease

AU - Sander, Stine Dydensborg

AU - Nybo Andersen, Anne-Marie

AU - Murray, Joseph A

AU - Karlstad, Øystein

AU - Husby, Steffen

AU - Størdal, Ketil

N1 - Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2019/6

Y1 - 2019/6

N2 - Background & Aims: The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics—especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease. Methods: We performed an observational nationwide register-based cohort study. We included all children born in Denmark from 1995 through 2012 or Norway from 2004 through 2012. Children born in Denmark were followed until May 8, 2015 (age at end of follow-up was 2.3–20.3 years) and children born in Norway were followed until December 31, 2013 (age at end of follow-up was 1–10 years). We collected medical information from more than 1.7 million children, including 3346 with a diagnosis of celiac disease. Exposure to systemic antibiotics was defined as a dispensed systemic antibiotic in the first year of life. Results: Exposure to systemic antibiotics in the first year of life was positively associated with diagnosed celiac disease in the Danish and Norwegian cohorts (pooled odds ratio 1.26, 95% confidence interval 1.16–1.36). We found a dose-dependent relation between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic 1.08, 95% confidence interval 1.05–1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts decreased the association slightly (pooled odds ratio 1.18, 95% confidence interval 0.98–1.39). Conclusion: In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics could be a risk factor for celiac disease.

AB - Background & Aims: The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics—especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease. Methods: We performed an observational nationwide register-based cohort study. We included all children born in Denmark from 1995 through 2012 or Norway from 2004 through 2012. Children born in Denmark were followed until May 8, 2015 (age at end of follow-up was 2.3–20.3 years) and children born in Norway were followed until December 31, 2013 (age at end of follow-up was 1–10 years). We collected medical information from more than 1.7 million children, including 3346 with a diagnosis of celiac disease. Exposure to systemic antibiotics was defined as a dispensed systemic antibiotic in the first year of life. Results: Exposure to systemic antibiotics in the first year of life was positively associated with diagnosed celiac disease in the Danish and Norwegian cohorts (pooled odds ratio 1.26, 95% confidence interval 1.16–1.36). We found a dose-dependent relation between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic 1.08, 95% confidence interval 1.05–1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts decreased the association slightly (pooled odds ratio 1.18, 95% confidence interval 0.98–1.39). Conclusion: In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics could be a risk factor for celiac disease.

KW - Autoimmunity

KW - Epidemiology

KW - Microbiome

KW - Population

U2 - 10.1053/j.gastro.2019.02.039

DO - 10.1053/j.gastro.2019.02.039

M3 - Journal article

VL - 156

SP - 2217

EP - 2229

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 8

ER -