Understanding Celiac Disease: What HEDIMED research has taught us about causes and prevention
Celiac disease, a condition where the immune system reacts abnormally to gluten, used to be considered rare. Today, it’s being diagnosed more than ever – especially in children. But this increase isn’t just due to better testing. Evidence suggests the disease itself is becoming more common, at least in certain countries (King et al. 2020).
Celiac disease presents with a wide range of symptoms, from digestive issues like constipation, diarrhea, and abdominal pain to extraintestinal manifestations. It can also cause dental enamel defects, liver abnormalities, bone density loss, joint pain, neurological symptoms, mood disorders, and even fertility problems. Symptoms may be mild or absent, making diagnosis challenging. A strict gluten-free diet typically helps alleviate or resolve many of these issues. (The Finnish Coeliac Society, 2025)
Overall, genes create a predisposition, gluten can act as a trigger, but other environmental factors also play a role. In this blog, we present a few examples HEDIMED has investigated.
Picture 1: Celiac disease can influence the daily life of the affected: While genes and gluten play a role, environmental factors may also help explain the rise and wide range of symptoms.
An alarming rise: Case Estonia
In Estonia, HEDIMED researchers tracked celiac disease trends in children from 1976 to 2020, and the results are eye-opening: According to Simre et al. (2025), the incidence of childhood celiac disease has increased almost 70-fold since the 1970s. Children are also being diagnosed at older age, and their symptoms are often mild or atypical, making the condition harder to detect. Interestingly, the rise in cases peaked around 2015–2016 and has declined slightly since then, but the overall increase remains dramatic. Importantly, this shift can’t be explained by better awareness or testing alone. It points toward environmental factors that may be making the disease more common in the population.
The hidden world of viruses and their possible role in celiac disease
Beneath the surface of our digestive system lies a hidden world filled with viruses. Many of them are still unknown to science. A recent HEDIMED study uncovered more than 9,000 previously unidentified viruses, likely bacteriophages – viruses that infect bacteria. What’s remarkable is that preliminary findings suggested that the composition of virome, or viral community, differed between children in early phases of celiac disease compared to similar children who remained healthy. The difference was very subtle and might be related to the presence of bacterial species – this warrants further investigation in the future (Cinek et al. 2024*).
Other research has pointed out more familiar viruses. Tapia et al. (2021) studied common gut infections in early childhood, focusing on parechovirus. Their findings were interesting: children who eventually developed celiac disease were more likely to have had a parechovirus infection earlier in life, even if they never showed symptoms. This suggests that everyday viral infections could push children who are already genetically predisposed toward developing celiac disease, acting as a trigger rather than the root cause. Another yet unpublished finding suggested a risk association between enterovirus infections and celiac disease.
Similarly, work by Hien et al. (2024*) looked at enteroviruses, another group of common childhood viruses. Their tentative discovery is that these infections could activate immune responses in the gut, possibly leading to increased production of a gene called TG2, which plays a key role in how the body reacts to gluten. These immune shifts may set the stage for celiac disease to develop. The findings open up the possibility of targeting virus-related pathways in the gut to prevent or delay disease onset in at-risk children.
Altogether, these studies suggest that viruses, though often unnoticed, could quietly shape the risk of celiac disease during a child’s early years – perhaps by disrupting the gut’s delicate immune balance at just the wrong moment.
The eaten exposome and celiac disease
Researchers set out to understand whether marine fatty acids, like those found in fish or supplements, might influence a child’s risk of developing celiac disease, either through the mother’s diet during pregnancy or through the child’s early intake.
Firstly, they looked at young children. Fish oil supplementation at 6 or 18 months of age, as well as fish intake at 18 months, showed no link to later development of celiac disease. However, certain genes, linked to lower levels of marine fatty acids in the body were borderline associated with an increased risk, suggesting a potential genetic influence. In addition, intake during pregnancy was explored. Neither the total amount of marine fatty acids consumed by mothers, nor the specific genes appeared to influence the child’s celiac risk. Interestingly though, taking marine fatty acid supplements during pregnancy was associated with a slightly higher risk of the child developing celiac disease. (Hård af Segerstad et al. 2025*). As for other nutrients, like vitamin A during pregnancy, no connection was found: The amount of vitamin A mothers consumed – whether below, at, or above recommended levels – showed no connection to their child’s risk of developing celiac disease. (Størdal et al. 2022*).
On a more hopeful note, another study found that babies who were introduced to a wider variety of foods early on had a lower risk of developing celiac disease, regardless of how much gluten they ate. So, offering infants a broad range of foods might be one small step toward lowering their risk. (Hård af Segerstad et al. 2024*).
Picture 2: Certain dietary supplements may influence the celiac disease risk.
In a clinical trial, Hurych (2023) examined whether probiotic supplements could influence gut parasites and bacteria in children with celiac disease autoimmunity – meaning they showed early immune signs of the disease. The probiotics did not change the presence of single-cell organisms like Blastocystis or Dientamoeba fragilis, but these organisms were linked with greater bacterial diversity, a generally positive sign. However, they were also associated with lower levels of some beneficial bacteria. Probiotic supplement was also explored by Jeníčková et al. (2023), looking at how the same probiotics influenced the chemical byproducts in the gut (the “faecal metabolome”). They found a modest but meaningful effect, especially in how proteins were broken down – a process that could influence immune health.
The father factor: Rethinking family and celiac disease risk
When thinking about the inherited risk for celiac disease, new findings suggest that fathers might deserve a closer look.
Recent initial evidence suggests that a paternal history of celiac disease may confer a higher risk to offspring than a maternal history. It is an interesting twist, especially since celiac disease is more commonly diagnosed in women. This female bias may have masked the pattern in clinics, where the affected mothers are simply more visible. The reasons behind this paternal influence are still unclear, but the research points to possible explanations like differences in how genes are passed from each parent, miscarriage linked to certain genotypes in mothers with celiac disease, or other environmental factors.
And that’s not all. Preliminary findings by Kivelä et al. (2024*) showed that father’s educational background with familial financial stability were linked to celiac disease diagnosis likelihood. In other words, it is possible that in families where parents, and specifically fathers, are more educated or health-aware, children are more likely to be checked, tested, and diagnosed.
Together, these findings hint at a bigger picture: both biology and behavior on the father’s side may quietly influence how celiac disease is detected in children.
Looking forward: Could a childhood test change the future of prevention?
As celiac disease quietly rises in prevalence, scientists are taking proactive steps to outpace it. A study by Mäkinen et al. (2024*) tackled a long-standing question in public health: Is mass screening for celiac disease in children worth the cost? Their early modeling results point cautiously toward yes – with a few annotations.
As most people with celiac disease remain undiagnosed for years, risking long-term health complications. To bridge this gap, this team ran simulations weighing the costs and benefits of various screening strategies, factoring in quality of life, healthcare use, absenteeism, and treatment success for instance. One potential takeaway? A single round of serological testing: screening for antibodies associated with celiac disease at age 11 hit the sweet spot for cost-effectiveness. Repeated screening (between ages 4-7 and 11-14) became worthwhile in several scenarios, including high disease prevalence, long diagnostic delays or high costs of undiagnosed celiac disease. Genetic pre-screening also resulted in repeated screening becoming the preferred approach; however, genetic testing was too expensive to justify its use for simulated population-based screening.
An earlier work (Mäkinen 2023) also examined a hypothetical enterovirus vaccine aimed at celiac disease prevention. Although promising in theory, the vaccine was not cost-effective at current price levels, highlighting the potential but also the hurdles of prevention-focused interventions.
Picture 3: Although some findings are still unpublished and further refinement is needed, the path forward is clear: early detection is feasible and increasingly relevant for policy.
For now, the findings suggest a targeted, proactive strategy might be within reach. If health systems adopt screening, they could probably reduce the burden of undiagnosed celiac disease before complications set in, offering both clinical and economic benefits. While some of the research remains unpublished and more work is needed to refine approaches, the direction is clear: early detection is not only possible, but it might also become policy relevant once more evidence is created.
With more tools to identify early warning signs, support gut health, and even prevent disease, we may be moving toward a future where celiac disease is easier to manage, or even avoid altogether. Until then, awareness and scientific progress remain our best defense against this often silent, but increasingly visible, immune-mediated condition.
Although HEDIMED’s active phase has come to an end, new insights into celiac disease are still on the horizon. Stay tuned!
Contributors
This text was written by Henna Numminen, with review and consulting contributions from Lars Stene, Ondrej Cinek, Kalle Kurppa, and Jani Mäkinen.
References
The Finnish Coeliac Society. Coeliac disease: https://www.keliakialiitto.fi/briefly-in-english/celiac-disease/ Ref in 06/2025.
King, James A., Jocelyn Jeong, Fox E. Underwood, Joshua Quan, Nicola Panaccione, Joseph W. Windsor, Stephanie Coward et al. “Incidence of celiac disease is increasing over time: a systematic review and meta-analysis.” Official journal of the American College of Gastroenterology| ACG 115, no. 4 (2020): 507-525. https://doi.org/10.14309/ajg.0000000000000523
HEDIMED Publications:
Hurych, Jakub, Elin Oscarsson, Åsa Håkanson, Kateřina Jirků-Pomajbíková, Milan Jirků, Carin Andrén Aronson, Ondřej Cinek, Daniel Agardh, and HEDIMED Investigator Group. “Effects of Lactiplantibacillus plantarum and Lacticaseibacillus paracasei supplementation on the single-cell fecal parasitome in children with celiac disease autoimmunity: a randomized, double-blind placebo-controlled clinical trial.” Parasites & Vectors 16, no. 1 (2023): 411. https://doi.org/10.1186/s13071-023-06027-1
Jeníčková, Eliska, Carin Andrén Aronsson, Anna Mascellani Bergo, Ondrej Cinek, Jaroslav Havlik, and Daniel Agardh. “Effects of Lactiplantibacillus plantarum and Lacticaseibacillus paracasei supplementation on the faecal metabolome in children with coeliac disease autoimmunity: a randomised, double-blinded placebo-controlled clinical trial.” Frontiers in Nutrition 10 (2023): 1183963. https://doi.org/10.3389/fnut.2023.1183963
Simre, Kärt, Heti Pisarev, Mari‐Liis Kumm, Marie Kaivo, and Oivi Uibo. “Has the Rise of Celiac Disease Incidence in Estonian Children Stopped?.” Acta Paediatrica (2025). https://doi.org/10.1111/apa.70092
Tapia, German, Kateřina Chudá, Christian R. Kahrs, Lars C. Stene, Lenka Kramna, Karl Mårild, Trond Rasmussen, Kjersti S. Rønningen, Ondřej Cinek, and Ketil Størdal. “Parechovirus infection in early childhood and association with subsequent celiac disease.” Official journal of the American College of Gastroenterology| ACG 116, no. 4 (2021): 788-795. 10.14309/ajg.0000000000001003 https://journals.lww.com/ajg/Fulltext/2021/04000
*) Scientific conference abstracts and posters:
The references listed below include conference abstracts and posters, which may present preliminary findings that have not yet undergone peer review; they offer context and indicate the direction of ongoing research but should not be used as the sole basis for strong conclusions.
Ondrej Cinek, Katerina Chuda, German Tapia, Klara Hubackova, Shiraz Shah, Jonathan Thorsen, et al. Gut virome composition modifies the risk of subsequent celiac disease in two European birth cohorts. ESCMID Global Conference abstract, 04/2025.
Hana Hien, Valeriia Dotsenko, Amirbabak Sioofy Khojine, Jutta Laiho, Heikki Hyöty, Keijo Viiri. Modelling enterovirus-induced predisposition to celiac disease: Single-cell transcriptomic analysis of Coxsackie B virus-infected organoids. ICDS & UEGW Conference abstracts, 2024.
Laura Kivelä, Elin M. Hård Af Segerstad, Aino K. Rantala, German Tapia, Lars C. Stene, Ketil Størdal, and the HEDIMED Investigator Group. Significance of parental socio-economic factors and early life healthcare utilization for the probability of the child’s celiac disease diagnosis. Digestive Disease Week conference abstract 2025 & ESPGHAN Conference 2025.
Jani Mäkinen: Cost-Effectiveness of Screening for Celiac Disease in Children. Master’s thesis. Aalto University. January 2023. http://urn.fi/URN:NBN:fi:aalto-202302071984
Jani Mäkinen, Paula Heikkilä, Juha Pajula, Khaoula El Mekkaoui, Ketil Størdal, Katri Lindfors, et al., and the HEDIMED Investigator Group. Use of simulation model to study the cost-effectiveness of different strategies for celiac disease screening in childhood. Digestive Disease Week conference abstract 2025.
Elin Hård af Segerstad, Annie Guo, Karl Mårild, Lars C. Stene, Anne Lise Brantsæter, Ketil Størdal, for the HEDIMED Investigator Group. Associations of early life dietary diversity and quality with celiac disease: The Norwegian Mother, Father and Child Cohort Study.
ICDS Conference abstract, 2024.
Elin Hård af Segerstad, Anne Lise Brantsæter, German Tapia, Lars C. Stene, Ketil Størdal, Nicolai Lund-Blix, for the HEDIMED Investigator Group. Early life marine fatty acid intake and metabolism and associations with the risk of coeliac disease. & Pregnancy marine fatty acid intake and metabolism and associations with the child’s risk of coeliac disease. ESPGHAN Conference posters, 2025.
Lars C. Stene, Aino-Kaisa Rantala, German Tapia, Christian M. Page, Ketil Størdal, and the HEDIMED Investigator Group. Relative risk of celiac disease in children differs by paternal versus maternal history of celiac disease. ICDS Conference abstract, 2024.
Ketil Størdal, Marit Z. Øien, Lars C. Stene, German Tapia, Nicolai A. Lund-Blix. Vitamin A intake during pregnancy and risk of offspring celiac disease: A HEDIMED study.
ICDS Conference abstract, 2022.
