# Environmental Factors Associated With Celiac Disease in Children in Southeast Iran: A Case–Control Study

## TL;DR

This study identifies environmental and maternal factors linked to celiac disease in children from southeastern Iran, highlighting the need for awareness and early diagnosis.

## Contribution

The study provides new insights into celiac disease risk factors in a region with limited prior research.

## Key findings

- Maternal BMI extremes and rural living are associated with increased celiac disease risk.
- Exclusive breastfeeding for 3 months and consanguine marriages are linked to higher CD risk.
- Premature rupture of membranes is associated with a reduced risk of celiac disease.

## Abstract

Celiac disease (CD) is a systemic autoimmune disease associated with several environmental factors in susceptible individuals. Given the lack of CD-related publications in the Mediterranean region as well as its prevalence in southeastern Iran, we decided to assess its potential risk factors.

In this case–control study, 200 children (100 CD and 100 non-CD patients) were recruited via convenience sampling. A survey assessing demographic and medical history (especially perinatal and maternal characteristics) was completed. Then, the odds ratios (ORs) were calculated through conditional logistic regression.

The risk of developing CD increased based on maternal BMI < 18.5 and > 30 kg/m2 (OR: 4.2, 95% CI: 1.3–13.2, and OR: 1.5, 95% CI: 0.6–3.7, respectively), living in rural areas (OR: 6.2, 95% CI: 2.6–14.2), use of antacids (OR: 7.4, 95% CI: 0.9–61.7), positive family histories of CD (OR: 11.8; 95% CI: 4.0–34.9), consanguine marriages (OR: 1.9, 95% CI: 1.1–3.5), and exclusive breastfeeding for 3 months (OR: 11, 95% CI: 1.3–87.6). Furthermore, premature rupture of membranes (OR: 0.489, 95% CI: 0.2–0.9) was associated with lower risks of CD.

There is a need to increase awareness of the factors associated with CD in both society and among healthcare providers, to not only reduce exposure but diagnose quicker.