Prevalence of occult celiac disease in females with iron deficiency in the United States: an NHANES analysis

Abstract

Aim: The prevalence of celiac disease (CD) in patients with iron deficiency (ID) is estimated at 0–6% in European countries. The prevalence of celiac disease in patients with iron deficiency in the USA is unknown. Given the treatable nature of gluten hypersensitivity, estimating the prevalence of CD in patients with ID can help to determine the need to screen these patients for occult CD. Methods: Data were obtained from the NHANES database, a nationally representative health survey conducted from 2009 to 2010. We included 2,105 females aged 6 years or older. Iron deficiency was defined as serum ferritin level <20 ng/ml and considered positive for celiac disease when subjects were tested positive for both immunoglobulin A (IgA) tissue transglutaminase antibody and IgA endomysial antibody. Subjects were divided between two groups (ID and non-ID). The association of CD and ID, which was the primary outcome, was obtained after adjusting for other covariates using logistic regression. Results: Among the sample of 2,105 subjects, 569 had ID and 1536 did not have ID. Five people were identified as having CD among the ID group, as were two people in the non-ID group. After adjusting for selected covariates, the prevalence of CD was higher in female subjects with ID with OR of 12.5 (95% CI 1.74–90). Conclusions: The overall prevalence of celiac disease in the USA’ female population is low, however, the prevalence is higher in subjects with iron deficiency. Further prospective studies are needed to validate our findings.

Food Insecurity Negatively Impacts Gluten Avoidance and Nutritional Intake in Patients With Celiac Disease

“…All data is collected by a study team that includes a physician and trained medical technicians, and interviewers. The NHANES survey has been used extensively to study the prevalence and characteristics of patients with CeD given the collection of medical, dietary, and laboratory data 3,17–23…”

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

“…The pooled diagnostic yield of random duodenal biopsies to assess for celiac sprue-like histologic changes in patients with IDA in the United States was low at 1.15% (95% CI, 0.89%-1.44%). The studies included data from 7993 patients and certainty of evidence was very low due to increased risk of bias (mainly selection bias) and serious imprecision [16][17][18]76,[99][100][101][102][103][104][105] ( Figure 7).…”

Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management

“…The prevalence of CD has also been investigated in patients with ID without anemia. Abdalla et al investigated a cohort of 2105 females aged 6 years or older, obtained from the NHANES database, a nationally representative health survey conducted from 2009 to 2010 [49]. ID was defined as serum ferritin level <20 ng/mL and considered positive for CD when subjects were tested positive for both immunoglobulin A (IgA)-tTGA tissue transglutaminase and IgA-EMA.…”

“…Figure2shows the reported prevalence of CD in patients investigated for ID anemia in different clinical settings [35][36][37][38]40,42,[44][45][46][47]49,51,56]. …”