Seroprevalence, correlates, and characteristics of undetected coeliac disease in England

Abstract

Objective: To examine the seroprevalence, correlates, and characteristics of undetected coeliac disease in a large adult population sample in Cambridge, UK. Methods: The Cambridge General Practice Health Study invited individuals from 12 general practices, aged 45-76 years, to attend for a health survey that included a bone density measurement, between 1990 and 1995. A total of 7550 participants' serum samples were tested for antiendomysial antibody (EMA). Seroprevalence of undetected coeliac disease was based on EMA positivity. Differences between EMA positive and negative participants of various physiological correlates and reported characteristics were estimated by multivariate logistic and linear regression and adjusted for age, sex, social class, and smoking behaviour. Results: The seroprevalence of undetected coeliac disease in this general population sample aged 45-76 was 1.2% (95% confidence interval (CI) 0.9-1.4). EMA positive participants (n=87) were on average slightly lighter by 2.2 kg (p=0.08), were more likely to have reported their general health as being "good or excellent" (odds ratio (OR) 1.76 (95% CI 0.90-3.46)), and were less likely to report being a current smoker (OR for current versus never 0.36 (95% CI 0.14-0.90)) than EMA negative participants. EMA positivity was associated with an 8% reduction in mean serum cholesterol (0.5 mmol/l; p<0.01) and reductions in mean haemoglobin (0.3 g/dl; p<0.01), total protein (1.0 g/l; p<0.05), and corrected serum calcium (0.02 mmol/l; p<0.05). There was an increased risk of osteoporosis in EMA positive participants (OR 3.1 (95% CI 1.3-7.2)) and of mild anaemia (OR 4.6 (95% CI 2.5-8.2)) compared with EMA negative participants. Conclusions: Undetected coeliac disease is likely to affect approximately 1% of the population of England aged 45-76 years, a value similar to several other countries. Those affected report "better health" but they do have an increased risk of osteoporosis and mild anaemia. In contrast, they have a favourable cardiovascular risk profile that may afford protection from ischaemic heart disease and stroke.

Age-related differences in celiac disease: Specific characteristics of adult presentation

“…Similar studies in Brazil and India also found twice the CD frequency in children [7,8] . However, these data are in contrast with the observed prevalence in adult populations from European countries such as the United Kingdom (1.2%) [9] and, more surprisingly, Finland, where a 2.4% prevalence of CD was demonstrated by biopsy in a population of adults over fifty years of age [10] . The pediatric population was not analyzed in these studies, but prevalence of over 1%, even in older populations, is similar to that observed in pediatric studies.…”

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

“…The major finding of this study is that CD is more prevalent in iron deficient females than in non-iron deficient females, which is in line with many different studies done in Europe [21,22] and Asia [8,23–25]. Also, the prevalence of CD in our patient population was 0.33% (1 in 303), which is lower than the results of studies in Europe [26–29]. …”

Mechanisms underlying celiac disease and its neurologic manifestations

“…Breast feeding and the timing of gluten introduction in the diet [8], viral infections that promote the secretion of interferon alpha [9] and smoking [10] are some of the factors that appear to influence the development of the disease. Recently it has been recognized that CD is one of the most common diseases encountered by physicians, occurring in 0.5%-1% of the population [11][12][13].…”