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OBJECTIVES: Sweden experienced a unique epidemic of celiac disease in children <2 years of age. The epidemic was partly explained by changes in infant feeding over time and indicated a multifactorial pathogenesis. The main aim of this study was to analyze celiac disease risk in epidemic and postepidemic birth cohorts up to preschool age, to explore further the opportunity for primary prevention. METHODS: A population-based incidence register of celiac disease in children covering the entire nation from 1998 to 2003 and part of the country back to 1973 was analyzed. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for celiac disease were used. The annual incidence rate for each age group and the cumulative incidence according to age for each birth cohort were calculated. RESULTS: A considerable difference in cumulative incidences of celiac disease at comparable ages was demonstrated between birth cohorts from the epidemic and postepidemic periods. The difference persisted during the preschool years, although it decreased somewhat with age. During the last years of the follow-up period, there was again a successive increase in incidence rate among children <2 years of age. CONCLUSIONS: The difference in celiac disease risk between birth cohorts at comparable ages suggests an opportunity for primary prevention. This highlights the importance of further exploring the role of infant feeding and exogenous factors besides dietary gluten that might initiate or prevent disease development. Moreover, on the basis of postepidemic incidence trends, we speculate that the Swedish epidemic might not have been as unique as thought previously, although its magnitude was striking.

AIM: To determine if there is any regional celiac disease (CD) risk variation in the Swedish childhood population. METHODS: Prospective nationwide Swedish incidence register of CD in children 0-15 years of age, with the present analysis covering the period from 1998 to 2003. ESPGHAN diagnostic criteria for CD were used. Regions were classified according to the Nomenclature of Territorial Units for Statistics. The incidence rate for each region, gender, age group and year of diagnosis was calculated. RESULTS: A regional variation in CD risk was demonstrated. The childhood populations in 'West Sweden' and 'Småland and the islands', situated in the southern part of the country, had a significantly higher incidence rate compared to in 'North Middle Sweden' and 'Stockholm', situated in the central part. This regional variation was not explained by variations in risk by gender, age at diagnosis or year of diagnosis. CONCLUSION: The Swedish regional variation in CD risk supports multifactorial disease aetiology. Continued efforts are warranted to define factors, besides gluten exposure, that modulate CD risk.

Background Noncompliance with the gluten-free diet is often reported among adolescents with coeliac disease. However, knowledge is limited regarding their own perspectives and experiences of managing the disease and the prescription of a gluten-free diet. The aim of this study was to explore how adolescents with coeliac disease perceive and manage their everyday lives in relation to a gluten-free diet. Methods in total, 47 adolescents with coeliac disease, divided into 10 focus groups, were interviewed. In the qualitative analysis, themes emerged to illustrate and explain the adolescents' own perspectives on life with a gluten-free diet. Results The probability of compliance with the gluten-free diet was comprised by insufficient knowledge of significant others, problems with the availability and sensory acceptance of gluten-free food, insufficient social support and their perceived dietary deviance. Three different approaches to the gluten-free diet emerged: compliers, occasional noncompliers, and noncompliers. Each approach, as a coping strategy, was rational in the sense that it represented the adolescents' differing views of everyday life with coeliac disease and a prescription of a gluten-free diet. Conclusions Adolescents with coeliac disease experience various dilemmas related to the gluten-free diet. The study demonstrated unmet needs and implies empowerment strategies for optimum clinical outcomes.

For adolescents with celiac disease (CD), a gluten-free diet(GFD) is crucial for health, but compliance is problematic andnoncompliance is common even among those aware of the risks.To better understand their lives with the disease, Swedish CDadolescents were invited to take part in focus group discussions.Data were analyzed for recurrent stigma-related themes acrossthe groups. Adolescents described an awareness of being differentfrom others that was produced by meal appearance and the pooravailability of gluten-free food. The GFD often required discussionsand special requests, so eating in public had the effect ofmaking an invisible condition visible, and thereby creatinga context for felt or enacted stigma. Maintaining invisibilityavoided negative consequences of stigma, and other strategieswere used to reduce the costs of visibility. The results ofthe study show that the GFD can produce stigma experiences inadolescence, and that dietary compliance (or lack thereof) canbe understood in terms of dealing with GFD concealment and disclosure.