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The World Incidence and Prevalence of Autoimmune Diseases is Increasing

DOI:10.12691/ijcd-3-4-8
Authors:
Aaron Lerner at . Chaim Sheba Medical Center, the Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel and Ariel University, Ariel, Israel
Aaron Lerner
  • . Chaim Sheba Medical Center, the Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel and Ariel University, Ariel, Israel
Wusterhausen Patricia at AESKU.KIPP Institute
Wusterhausen Patricia
  • AESKU.KIPP Institute
Torsten Matthias
Torsten Matthias
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Abstract and Figures

Epidemiological data provide evidence of a steady rise in autoimmune disease throughout Westernized societies over the last decades. Multiple publications exist, describing past or actual incidences/prevalence of individual autoimmune diseases, however, long term studies on selected populations are scarce. Aims: to calculate the % increases per year of autoimmune diseases frequencies worldwide, analyze the differential increases per country and disease, and identify geoepidemiological trends. Methods: A systematic review was performed to identify incidence and prevalence of autoimmune diseases. 30 Studies from the last 30 years were identified using Medline, Google, and Cochrane Library databases. Only long-term regional or national follow-ups are reported. Results: The means ± s.d. of the net % increased /year incidence and prevalence of autoimmune diseases worldwide were 19.1±43.1 and 12.5±7.9, respectively. Rheumatic, endocrinological, gastrointestinal and neurological autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of these, differences between old vs new frequencies were highly significant (p < 0.0001). Comparing various autoimmune diseases, celiac disease increased the most and the highest increase in incidence, comparing old to new surveys is allocated to myasthenia gravis. Despite considerable variations between the countries, celiac, type 1 diabetes and myasthenia gravis frequencies increased the most in Canada, Israel and Denmark, respectively. Frequencies of the autoimmune diseases increased significantly in the West and North when compared to East and South, respectively. Conclusions: Despite multiple reports on autoimmune diseases frequencies, long-term longitudinal follow-ups are scarce. Incidences and prevalences have increased significantly over the last 30 years. Rheumatic, endocrinological and gastrointestinal autoimmune diseases in Israel, Netherlands, USA and Sweden increased the most. These observations point to a stronger influence of environmental factors as opposed to genetic factors on autoimmune disease development.
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International Journal of Celiac Disease, 2015, Vol. 3, No. 4, 151-155
Available online at http://pubs.sciepub.com/ijcd/3/4/8
© Science and Education Publishing
DOI:10.12691/ijcd-3-4-8
The World Incidence and Prevalence of Autoimmune
Diseases is Increasing
Aaron Lerner1,*, Patricia Jeremias2, Torsten Matthias2
1B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
2AESKU.KIPP Institute, Wendelsheim, Germany
*Corresponding author: aaronlerner1948@gmail.com
Received September 27, 2015; Revised October 29, 2015; Accepted November 11, 2015
Abstract Epidemiological data provide evidence of a steady rise in autoimmune disease throughout Westernized
societies over the last decades. Multiple publications exist, describing past or actual incidences/prevalence of
individual autoimmune diseases, however, long term studies on selected populations are scarce. Aims: to calculate
the % increases per year of autoimmune diseases frequencies worldwide, analyze the differential increases per
country and disease, and identify geoepidemiological trends. Methods: A systematic review was performed to
identify incidence and prevalence of autoimmune diseases. 30 Studies from the last 30 years were identified using
Medline, Google, and Cochrane Library databases. Only long-term regional or national follow-ups are reported.
Results: The means ± s.d. of the net % increased /year incidence and prevalence of autoimmune diseases worldwide
were 19.1±43.1 and 12.5±7.9, respectively. Rheumatic, endocrinological, gastrointestinal and neurological
autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of
these, differences between old vs new frequencies were highly significant (p< 0.0001). Comparing various
autoimmune diseases, celiac disease increased the most and the highest increase in incidence, comparing old to new
surveys is allocated to myasthenia gravis. Despite considerable variations between the countries, celiac, type 1
diabetes and myasthenia gravis frequencies increased the most in Canada, Israel and Denmark, respectively.
Frequencies of the autoimmune diseases increased significantly in the West and North when compared to East and
South, respectively. Conclusions: Despite multiple reports on autoimmune diseases frequencies, long-term
longitudinal follow-ups are scarce. Incidences and prevalences have increased significantly over the last 30 years.
Rheumatic, endocrinological and gastrointestinal autoimmune diseases in Israel, Netherlands, USA and Sweden
increased the most. These observations point to a stronger influence of environmental factors as opposed to genetic
factors on autoimmune disease development.
Keywords: autoimmune disease, incidence, prevalence, surge, geoepidemiology
Cite This Article: Aaron Lerner, Patricia Jeremias, and Torsten Matthias, “The World Incidence and
Prevalence of Autoimmune Diseases is Increasing.” International Journal of Celiac Disease, vol. 3, no. 4 (2015):
151-155. doi: 10.12691/ijcd-3-4-8.
1. Introduction
Increasing evidence is accumulating for a steady rise in
the frequency of autoimmune diseases (AD), in the last
decades [1]. In fact, the rise in ADs parallels the surge in
allergic and cancer conditions while infections are less
frequent in the Western societies, creating the basis for the
hygiene hypothesis [2]. Multiple sclerosis (MS), type 1
diabetes (IDDM), inflammatory bowel diseases (mainly
Crohn’s disease) (IBD), systemic lupus erythematosus
(SLE), primary biliary cirrhosis, myasthenia gravis (MS),
autoimmune thyroiditis (AT), hepatitis and rheumatic
diseases (RA), bullous pemphigoid, and celiac disease
(CD) are several examples [3,4]. Their relationship to
socioeconomic status, their rapid increase in developed
countries and observations in selected migrant populations,
indicate some form of environmental impact, rather than
long-term genetic influences which are driving these
recent evolutionary processes [1,2,3,4,5]. Among many
others, three major environmental factors, strongly related
to socioeconomical status are suspected to drive these
phenomena: infections, ecology and nutrition. The
purpose of the present review is to calculate the surge per
year of AD frequencies worldwide and analyze the
differential increases of AD per country and disease
identifying geoepidemiological trends. There is a plethora
of publications on the incidences/prevalences of ADs in
medical literature, most of them describe past or actual
frequencies of individual ADs, however, long term
comparative follow-up studies on selected populations, in
individual countries are scarce.
2. Methods
A Medline search was performed using the following
search words: autoimmune disease or syndrome, incidence,
prevalence or frequency, spanning the period 1985-2015.
152 International Journal of Celiac Disease
Special emphasis was given to the identification of
increase/surge or decrease in incidence/prevalence
worldwide. Suitable publications were identified by
periodical scans of PubMed but also Google, and the
Cochrane Library databases, were screened. Original
papers, in the English language, especially those on
epidemiology of autoimmune diseases commonly
encountered, were identified. Foreign language papers
with English abstracts were also identified. Only long-
term regional or national longitudinal follow-ups are
reported. Hospital archived data, specific high-risk groups
or case reports, were excluded. Entities were validated and
used when directly stating at least one of the
abovementioned epidemiological indices. Chi-square test
or Fisher`s exact test were used for categorical data and p-
values less than 0.05 were considered as statistically
significant. Statistical analyses were performed using the
statistics software MedCalc version 15.6.1.
3. Results
30 studies were identified. The means ± s.d. of the
net % increased /year incidence and prevalence of ADs
worldwide were 19.1±43.1 and 12.5±7.9, respectively
(Figure 1). Of interest, grouping the different ADs to
disease categories, the highest net % increase per year was
noted in the rheumatologic (7.1), followed by endocrine
(6.3), gastrointestinal (6.2) and neurological diseases (3.7).
In all of these, differences between old vs new frequencies
were highly significant (p< 0.0001) (Figure 2). The table
inserted in Figure 2 details the diseases and the countries
included in the 4 disease categories.
Figure 1. The net % increase/year of the incidence and prevalence of
autoimmune diseases worldwide
Figure 2. (A) The net %/year increases of diseases’ categories. (B) The table below is detailing the different diseases and countries surveyed
The net increase/year of various diseases in specific
countries and old vs. new surveys of incidence/prevalence
of various autoimmune diseases, are shown in Figure 3A
and 3B, respectively. Figure 3A shows the total net
increase of Old vs. New surveys of incidence/prevalence
of various autoimmune diseases, (mean time interval RA
14.5, AT 13.5, Chron`s 11.5, IBD 11.0, IDDM 17.8,
Celiac 16.8 and MG 27 years, respectively), During the
reported time interval. CD increased the most
(26.3/year %) and the higher increase in incidence,
comparing old to new surveys is allocated to MG (432%)
(Figure 3A and Figure 3B). Geoepidemiologically, the
following countries had high to low % increases /year of
AD frequencies: Israel, Netherlands, USA, Sweden, UK,
Finland, Canada, and Denmark with 12.9, 10.0, 8.8, 8.4,
7.8, 7.6, 7.3 and 6.3 %, respectively. There was no
statistically significant difference between children and
adults in the increase of AD incidence/ prevalence
(p=0.8036). Figure 4 shows, as an example, two frequent
ADs like CD and IDDM and one, less frequent one like
MG surveys in various countries. A considerable variation
is noticed between the countries. CD, IDDM and MG
International Journal of Celiac Disease 153
frequencies increased the most in Canada, Israel and Denmark, respectively.
Figure 3. (A) Old vs. New surveys of incidence/prevalence of various autoimmune diseases. (B) The list of various diseases in specific countries and
the years’ ranges
Figure 4. The net increase %/year of 3 autoimmune diseases in the surveyed countries
154 International Journal of Celiac Disease
The geoepidemiologic trend of the net increase %/year
of the various ADs is described in Figure 5. Frequencies of the ADs increased significantly in the West and North
when compared to East and South, respectively.
Figure 5. The geoepidemiology of the net increase %/year of autoimmune diseases
4. Discussion
Population-based estimates of the incidence/prevalence
of ADs in different countries are crucial for investigating
possible etiologies or influencing environmental factors or
underlining risk factors.
Quantification of the likely healthcare burden and the
planning of future strategies to face the ongoing epidemic
of ADs is of no less importance. More so, the beneficial
aspects of early recognition of ADs are well known.
Multiple AD related complications can be prevented or
treated when the disease is diagnosed early enough. The
increased awareness responsible for the surge in
diagnosed patients, needs to continue together with a
lower threshold for screening high risk populations using
a cheap, non-invasive and reliable antibody biomarker to
prevent delays in diagnosing such a common but
preventable disease [6,7,8].
The net increased incidences/prevalences of ADs in the
Northern and Western countries, compared to the Southern
and Eastern ones follows the global geoepidemiological
trends of autoimmune diseases [9,10]. By reviewing
available literature, it can be deduced that frequency of
ADs have increased significantly over the last 30 years.
The recent outbreak of autoimmune diseases in
industrialized countries has brought into question the
factors contributing to this increased incidence. Given the
constancy of genetics, growing attention has focused on
environmental factors, and in particular, the western
lifestyle [3,4,11]. Indeed, over the last few decades
significant changes in western dietary habits,
environmental surroundings and pollution exposure,
infectious habitat and stress load, have led to a parallel
rise in autoimmune diseases. Thus, ADs occupies an
important place in this environmental mosaic of
autoimmunity, allergy and cancer surges [2].
The present study can serve as a platform for
geoepidemiological inquiries, concerning offending/
defending environmental changes. If CD is taken as an
example, how comes the surge in the disease frequency
was much higher in Canada, Israel and Netherlands,
compared to the low rates in Estonia and New Zealand?
Considering the diseases, what environmental forces
contributed to the higher surge of CD and MG, compared
to IBD and IDDM? Comparing the disease categories,
why are rheumatic disease surges higher than the
neurological ones? Is it the infectious or stress loads? The
intestinal disbiosis allocated to specific diseases? Driving
openers of the intestinal tight-junctions? Or is it the
increased public/professional awareness or the improved
diagnosis? A vast list of questions and so few answers.
The present study has multiple biases and drawbacks.
The follow up surveys were not done by the same team
nor by the same methodology, some of the relevant
studies might have escaped detection, the genetic makeup
and the environment are different in the screened countries,
the environmental forces are dynamic and most probably
changed during the last decades, the actual public and
professional awareness to autoimmunity and the
diagnostic bio-markers have evolved tremendously.
Despite those biases, the present study highlights the
significant surge in AD incidence and prevalence, detailing
the variations in disease entities and the corresponding
countries and substantiate the geoepidemiological trends.
The present literature survey is not aiming to investigate
etiologies or environmental factors affecting autoimmune
induction or progression. It is expected that an improved
knowledge of the worldwide distribution of autoimmune
disorders will help to understand the role of different
genetic factors and different environmental influences
involved in autoimmunogenesis. At a public level the
epidemiological studies are necessary to assess the social
and economic burdens impacting the health systems in the
different countries, and worldwide.
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... To further understand how individuals make sense of autoimmune disease, an illness experience growing in prevalence (Lerner et al., 2015), we interviewed 25 assigned female at birth individuals with autoimmune disease about their illness experiences. Employing the theoretical framework of communicated narrative sense making (Koenig Kellas, 2018, we thematically analyzed (Braun & Clarke, 2019) the salient meanings, values, and beliefs that participants assign to their illness experiences. ...
... Of recent note, there are overlaps to be found between stories of chronic illness and the COVID-19 pandemic (Krebs, 2022), notably the permeability of the master narrative of illness as restitution (Frank, 1995) and need to "return to normal," as recounted by participants. Sharing stories of chronic illness onset at a young age is important, especially given increasing rates of AD in young people (Lerner et al., 2015) due to environmental activators (i.e., a COVID-19 infection; Anaya et al., 2022). Furthermore, lessons learned through stories of AD highlight inequities in our health system, offering opportunities to improve care. ...
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... As per previous studies, increase incidence and prevalence of AID's is seen mostly in western countries but even India is seeing a gradual increase in incidence and prevalence of AID's from the last few years, still, the US standing first. [9] The gender wise distribution resulted that the majority of the patients with AID's were females which were 63.6% and males were around 36.4%. The male to female ratio observed in our study was approximately 2:1 (1.8:1). ...
... Guillain-Barre's syndrome IBD AITD SLE Rheumatoid arthritis CIDP with 1.8% (2 cases), psoriatic arthritis with 0.9% (1 case), cholangitis with 0.9% (1case). [9,12] Out of 70 females, 6 were unmarried and 64 were married (mothers). The ratio of prevalence of AID's in married to unmarried women was 9:1 approximately. ...
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... GD is an uncommon disease, and its prevalence/incidence has remained stable over the years [5,6], whereas autoimmune thyroiditis (namely, HT), is very common, affecting about 3-5% of the general population, and its incidence has been increasing [7][8][9]. In recent decades, large epidemiological studies have reported increased prevalence and incidence of several autoimmune disorders, including rheumatic (systemic lupus erythematosus, rheumatoid arthritis, to Nutrients 2023, 15, 3953 2 of 22 mention a few), neurological (multiple sclerosis, myasthenia gravis), gastro-enteric (inflammatory bowel diseases, celiac disease) and endocrine (such as autoimmune thyroiditis, type 1 diabetes) diseases, mostly in developed countries of the West and North compared to developing countries of the East and South [10][11][12]. ...
... Such an increase clearly correlates with improved hygiene and health standards, as well as with socioeconomic status, suggesting that environmental factors are driving these geo-epidemiologic changes [1,[10][11][12]. In particular, interest has been increasing in the "modern" lifestyle of industrialized, "westernized" societies, and to the potential environmental triggers that characterize it, including, for instance, reduced microbial exposures and improved hygiene, pollutants, psychological stress overload, deficiencies or excess of nutrients (notably, vitamin D, iodine, and selenium, to mention a few), whose role in autoimmunity is intensely debated [12][13][14][15][16][17][18][19][20]. ...
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Microbial transglutaminase (mTG) is a bacterial survival factor, frequently used as a food additive to glue processed nutrients. As a result, new immunogenic epitopes are generated that might drive autoimmunity. Presently, its contribution to autoimmunity through epitope similarity and cross-reactivity was investigated. Emboss Matcher was used to perform sequence alignment between mTG and various antigens implicated in many autoimmune diseases. Monoclonal and polyclonal antibodies made specifically against mTG were applied to 77 different human tissue antigens using ELISA. Six antigens were detected to share significant homology with mTG immunogenic sequences, representing major targets of common autoimmune conditions. Polyclonal antibody to mTG reacted significantly with 17 out of 77 tissue antigens. This reaction was most pronounced with mitochondrial M2, ANA, and extractable nuclear antigens. The results indicate that sequence similarity and cross-reactivity between mTG and various tissue antigens are possible, supporting the relationship between mTG and the development of autoimmune disorders 150W.
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Serological Markers and/or Intestinal Biopsies in the Case-finding of Celiac Disease
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Full-text available
  • May 2016
The new 2012 ESPGHAN guidelines for the pediatric diagnosis of celiac disease (CD) unraveled and stimulated an old/new discussion on the most efficient case- finding in pediatric CD. The fine balance between reliable serological markers and the gold diagnostic standard of small bowel histology is somewhat better understood. Due to a low diagnostic rate, changes in phenotype, increased incidence, epidemiological shifts, importance of early implementation of gluten free diet to prevent complications, the case-finding of CD should be improved. Our adult gastrointestinal colleagues did not adopt ESPGHAN diagnostic criteria and within the pediatric gastroenterology community, controversies exist. The present editorial on pediatric CD complements an adult CD one. It expands on the drawbacks, limitations and criticisms of the guidelines and calls for prudency, further research and follow-up studies. Until recent observations are implemented in the future guidelines, small bowel histology should remain the gold standard for case-finding in CD.
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Increased Knowledge and Awareness of Celiac Disease will Benefit the Elderly
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  • Sep 2015
Celiac disease, once deemed to be primarily a pediatric disease, is accepted nowadays as a lifelong disease that increasingly affects the elderly. In older patients it is late and underdiagnosed, it is hypo-or asymptomatic and case finding strategy is recommended. Gluten restrictive therapy is problematic but manageable and beneficial, improving symptoms, serology, histology and preventing complications. Increased knowledge and awareness on CD in the third age and a comprehensive, multidisciplinary and holistic approach will improve their outcome.
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Possible association between celiac disease and bacterial transglutaminase in food processing: a hypothesis
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The incidence of celiac disease is increasing worldwide, and human tissue transglutaminase has long been considered the autoantigen of celiac disease. Concomitantly, the food industry has introduced ingredients such as microbial transglutaminase, which acts as a food glue, thereby revolutionizing food qualities. Several observations have led to the hypothesis that microbial transglutaminase is a new environmental enhancer of celiac disease. First, microbial transglutaminase deamidates/transamidates glutens such as the endogenous human tissue transglutaminase. It is capable of crosslinking proteins and other macromolecules, thereby changing their antigenicity and resulting in an increased antigenic load presented to the immune system. Second, it increases the stability of protein against proteinases, thus diminishing foreign protein elimination. Infections and the crosslinked nutritional constituent gluten and microbial transglutaminase increase the permeability of the intestine, where microbial transglutaminases are necessary for bacterial survival. The resulting intestinal leakage allows more immunogenic foreign molecules to induce celiac disease. The increased use of microbial transglutaminase in food processing may promote celiac pathogenesis ex vivo, where deamidation/transamidation starts, possibly explaining the surge in incidence of celiac disease. If future research substantiates this hypothesis, the findings will affect food product labeling, food additive policies of the food industry, and consumer health education. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute.
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Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease
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The incidence of autoimmune diseases is increasing along with the expansion of industrial food processing and food additive consumption. The intestinal epithelial barrier, with its intercellular tight junction, controls the equilibrium between tolerance and immunity to non-self-antigens. As a result, particular attention is being placed on the role of tight junction dysfunction in the pathogenesis of AD. Tight junction leakage is enhanced by many luminal components, commonly used industrial food additives being some of them. Glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles are extensively and increasingly used by the food industry , claim the manufacturers, to improve the qualities of food. However, all of the aforementioned additives increase intestinal permeability by breaching the integrity of tight junction paracellular transfer. In fact, tight junction dysfunction is common in multiple autoimmune diseases and the central part played by the tight junction in autoimmune diseases pathogenesis is extensively described. It is hypothesized that commonly used industrial food additives abrogate human epithelial barrier function, thus, increasing intestinal permeability through the opened tight junction, resulting in entry of foreign immunogenic antigens and activation of the autoimmune cascade. Future research on food additives exposure-intestinal permeability-autoimmunity interplay will enhance our knowledge of the common mechanisms associated with autoimmune progression. Copyright © 2015. Published by Elsevier B.V.
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Increasing Incidence of Celiac Disease in a North American Population
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Objectives: The prevalence of celiac disease (CD) varies greatly, potentially because of incomplete ascertainment of cases and small study samples with limited statistical power. Previous reports indicate that the incidence of CD is increasing. We examined the prevalence of CD in a well-defined US county. Methods: Population-based study in Olmsted County, Minnesota, USA. Using the infrastructure of the Rochester Epidemiology Project, medical, histopathology, and CD serology records were used to identify all new cases of CD in Olmsted County since 2000. Age- and sex-specific and adjusted (to the US white 2000 population) incidence rates for CD were estimated. Clinical presentation at diagnosis was also assessed. Results: Between 2000 and 2010, 249 individuals (157 female or 63%, median age 37.9 years) were diagnosed with CD in Olmsted County. The overall age- and sex-adjusted incidence of CD in the study period was 17.4 (95% confidence interval (CI)=15.2-19.6) per 100,000 person-years, increasing from 11.1 (95% CI=6.8-15.5) in 2000-2001 to 17.3 (95% CI=13.3-21.3) in 2008-2010. The temporal trend in incidence rates was modeled as a two-slope pattern, with the incidence leveling off after 2004. Based on the two classic CD symptoms of diarrhea and weight loss, the relative frequency of classical CD among incident cases decreased over time between 2000 and 2010 (P=0.044). Conclusions: The incidence of CD has continued to increase in the past decade in a North-American population.
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Explosion of autoimmune diseases and the mosaic of old and novel factors
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In recent decades, an enormous effort has been made to elucidate the pathogenesis of autoimmune and autoinflammatory diseases. Autoimmunity is a multifactorial process in which genetic, immunological, environmental and hormonal factors play in concert, together representing what was termed years ago the 'mosaic of autoimmunity'. To date, more than 80 systemic and organ-specific autoimmune diseases have been defined, and their cumulative burden is substantial, both medically and financially. Furthermore, the burden of autoimmune and autoinflammatory diseases is rising, making these diseases a ubiquitous global phenomenon that is predicted to further increase in the coming decades. In this issue of the journal, additional aspects of autoimmunity are detailed. Immune dysregulation and loss of self-tolerance are the cornerstones of autoimmunity.
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Google-driven search for big data in autoimmune geoepidemiology: Analysis of 394,827 patients with systemic autoimmune diseases
Article
  • Apr 2015
Systemic autoimmune diseases (SAD) are a significant cause of morbidity and mortality worldwide, although their epidemiological profile varies significantly country by country. We explored the potential of the Google search engine to collect and merge large series (>1,000 patients) of SAD reported in the Pubmed library, with the aim of obtaining a high-definition geoepidemiological picture of each disease. We collected data from 394,827 patients with SAD. Analysis showed a predominance of medical vs. administrative databases (74% vs. 26%), public health system vs. health insurance resources (88% vs. 12%) and patient-based vs. population-based designs (82% vs. 18%). The most unbalanced gender ratio was found in primary Sjögren syndrome (pSS), with nearly 10 females affected per 1 male, followed by systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and antiphospholipid syndrome (APS) (ratio of nearly 5:1). Each disease predominantly affects a specific age group: children (Kawasaki disease, primary immunodefficiencies and Schonlein-Henoch disease), young people (SLE Behçet disease and sarcoidosis), middle-aged people (SSc, vasculitis and pSS) and the elderly (amyloidosis, polymyalgia rheumatica, and giant cell arteritis). We found significant differences in the geographical distribution of studies for each disease, and a higher frequency of the three SAD with available data (SLE, inflammatory myopathies and Kawasaki disease) in African-American patients. Using a "big data" approach enabled hitherto unseen connections in SAD to emerge. Copyright © 2015 Elsevier B.V. All rights reserved.
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Role of “Western Diet” in Inflammatory Autoimmune Diseases
Article
Developed societies, although having successfully reduced the burden of infectious disease, constitute an environment where metabolic, cardiovascular, and autoimmune diseases thrive. Living in westernized countries has not fundamentally changed the genetic basis on which these diseases emerge, but has strong impact on lifestyle and pathogen exposure. In particular, nutritional patterns collectively termed the "Western diet", including high-fat and cholesterol, high-protein, high-sugar, and excess salt intake, as well as frequent consumption of processed and 'fast foods', promote obesity, metabolic syndrome, and cardiovascular disease. These factors have also gained high interest as possible promoters of autoimmune diseases. Underlying metabolic and immunologic mechanisms are currently being intensively explored. This review discusses the current knowledge relative to the association of "Western diet" with autoimmunity, and highlights the role of T cells as central players linking dietary influences to autoimmune pathology.
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The last two millennias echo-catastrophes are the driving forces for the potential genetic advantage mechanisms in celiac disease
Article
  • Aug 2011
Many human genes have adapted to the constant threat of exposure to changing environmental conditions. Balancing selection is the result of an initial stage of positive selection that favors the spread in a population of a new allele until selection opposes its fixation and balanced situation is established. It is suggested that the disadvantageous celiac patients survived the last two millennias echo-catastrophes by adapting to the extreme temperature changes and their consequences in Europe. Genetic selective diversity induced by changing environment, enabled the celiac population to survive. Such a genetic positive selection is represented by the HEF C282Y mutation of hemochromatosis, SH2B3 loci and the HLA celiac disease-associated repertoire, enabling the celiac to overcome iron deficiency anemia and micro pathogen richness, respectively. The increased incidence of those evolutionary events in the celiac patients is a recent phenomenon that occurred in the latest era of the modern human history. The present hypothesis can shed light on additional selective genetic adaptations, echo catastrophe-driven that are at the basis of autoimmune disease-affected population survival and current expansion.
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