Lower economic status and inferior hygienic environment may protect against celiac disease

Ann Med. 2008;40(3):223-31. doi: 10.1080/07853890701678689.


Background: The populations in adjacent Russian Karelia and Finland are equally exposed to grain products and share partly the same ancestry, but live in completely different socioeconomic environments.

Aim: This creates an ideal epidemiological setting to study gene-environmental interactions in pathogenesis of celiac disease.

Methods: The prevalence of celiac disease and predisposing human leukocyte antigen (HLA) alleles was compared between Russian Karelia and Finland. Tissue transglutaminase antibodies and HLA-DQ alleles were screened from 1988 schoolchildren from Karelia and 3654 children from Finland. Children with transglutaminase antibodies were invited to small-bowel biopsy. Results. Transglutaminase antibodies were less frequent in Russian Karelia than in Finland (0.6% versus 1.4%, P = 0.005). Immunoglobulin class G (IgG) antigliadin antibodies were also less frequent in Russian Karelia (10.2% versus 28.3%, P<0.0001). Celiac disease was confirmed by duodenal biopsy in four of the eight transglutaminase antibody-positive Karelian children, giving a prevalence of 1 in 496 compared to 1 in 107 children in Finland. The same HLA-DQ alleles were associated with celiac disease and transglutaminase antibody positivity in both populations.

Conclusions: The prevalence of transglutaminase antibodies and celiac disease is lower in Russian Karelia than in Finland. This may be associated with a protective environment characterized by inferior prosperity and standard of hygiene in Karelia.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Alleles
  • Autoantibodies / immunology
  • Biopsy
  • Celiac Disease / diagnosis
  • Celiac Disease / epidemiology*
  • Celiac Disease / immunology
  • Child
  • Diet
  • Duodenum / pathology
  • Female
  • Finland / epidemiology
  • Gliadin / immunology
  • HLA-DQ Antigens / immunology*
  • Humans
  • Hygiene / standards*
  • Immunoglobulin G / immunology
  • Male
  • Prevalence
  • Russia / epidemiology
  • Socioeconomic Factors
  • Transglutaminases / immunology*


  • Autoantibodies
  • HLA-DQ Antigens
  • Immunoglobulin G
  • Gliadin
  • Transglutaminases