Because celiac disease is greatly under-diagnosed in the United States, a common assumption is that U.S. doctors and researchers always have considered the condition extremely rare. However, the disorder captured widespread medical attention at the beginning of the twentieth century. Luther Emmett Holt, a leading pediatrician, encouraged three other doctors to investigate the condition. Two helped to associate celiac disease with elite medical institutions. The third linked it to the marketing efforts of the United Fruit Company. Interest in celiac declined after 1965, partly as a result of the decreased concern with nutrition and nutritional disorders.