What Factors Contribute to Celiac Disease Risk in Kids?

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1. You are a member of the healthcare team advising a large pediatric practice about anticipated use for celiac disease (CD). On the basis of the analysis of data from The Environmental Determinants of Diabetes in the Young (TEDDY) study by Liu and colleagues, which one of the following statements about regional differences in celiac disease autoimmunity (CDA) and CD cumulative incidence for children born between 2004 and 2010 is correct?
   Across all sites, CD incidence by age 10 years was highest in Colorado children
   Individual haplogenotype risks for CDA and CD varied by region and affected cumulative incidence within that region
   Adjustment for human leukocyte antigen (HLA), sex, and family history abolished regional differences in CD risk
   In post hoc sensitivity analysis, lowering tissue transglutaminase autoantibodies (tTGA) cutoff to an average 2-visit tTGA of 67.4 or higher abolished regional differences in CD risk
2. On the basis of the analysis of data from the TEDDY study by Liu and colleagues, which one of the following statements about clinical implications of regional differences in CDA and CD cumulative incidence for children born between 2004 and 2010 is correct?
   Regional differences in CD incidence are solely explained by detection biases from varying biopsy rates
   The study proves that HLA haplogenotypes are the underlying cause of CD
   Clinicians should screen for CD only in children with symptoms
   The findings may inform policy regarding screening practices and support mass screening efforts, particularly in areas of higher relative risk