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Rates of Celiac Disease Continue to Rise Worldwide

It’s curious to think there was a time when the words “gluten” and “celiac disease” weren’t part of the common vernacular. Over the last few decades, rates of celiac disease have grown where it is now considered a major public health problem worldwide.1 In fact, a 2018 meta-analysis shows that pooled global prevalence of celiac disease is 1.4%, based on serologic tests. The prevalence values for celiac disease are 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence is higher in females versus males and is also significantly greater in children than adults.1

Until a few decades ago, celiac was considered to be an uncommon disease affecting mainly children and limited to individuals of European ancestry.1 As such, initial prevalence studies in the general population came from European countries. It was estimated to affect approximately 1% of that population; celiac disease was later reported in other parts of the world with predominant Caucasian populations. However, in the past few decades population-based data has been reported on celiac disease from areas like the Middle East, India, and Latin America.1

Furthermore, the prevalence of undiagnosed celiac disease seems to have increased dramatically in the US in the last 50 years.2 In the following video, renowned celiac researcher Alessio Fasano, MD, speaks with IFM educator Patrick Hanaway, MD, on how research has changed estimated prevalence rates of celiac disease in the US.

Celiac is not the only autoimmune condition increasing in prevalence – so, too, is type 1 diabetes.3 Interestingly, between 10% and 30% of patients with celiac disease are thyroid and/or type 1 diabetes antibody positive, while around 5% to 7% of patients with autoimmune thyroid disease and/or type 1 diabetes are IgA anti-tissue transglutaminase antibody positive.4 And while the close relationship between celiac disease and endocrine autoimmunity is largely explained by sharing a common genetic background,4 researchers speculate that the cause of the rise of the disease is likely environmental and linked to gluten intolerance.5

In celiac disease, gluten has been established as the instigator of autoimmunity; the classical presentation consists of gastrointestinal symptoms associated with malabsorption including diarrhea, steatorrhea, weight loss, or failure to thrive.5 Other symptoms include iron deficiency, recurrent abdominal pain, aphthous stomatitis, chronic fatigue, short stature and reduced bone density. The autoimmune process is halted by removing gluten from the diet, which allows for resolution of celiac autoimmune enteropathy and subsequent normalization of serological markers of the disease.5

The main treatment for celiac disease is a strict, lifelong adherence to a gluten-free diet.6 Yet alarmingly, 2018 research suggests that some “gluten-free” foods sold in the US actually contain trace levels of the substance that contribute to symptoms and persistent intestinal histologic damage.7 If left undiagnosed, celiac disease can be life-threatening. A 2009 study of 9,133 healthy young adults at Warren Air Force Base found, during 45 years of follow-up, that undiagnosed celiac disease was associated with a nearly 4-fold increased risk of death.2

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References:

  1. Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836.e2. doi 10.1016/j.cgh.2017.06.037.
  2. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. 2009;137(1):88-93. doi 10.1053/j.gastro.2009.03.059.
  3. Dr. FAQ: Stefano Guandalini on the Rise of Celiac Disease. Science Life. 2014.
  4. Kahaly GJ, Frommer L, Schuppan D. Celiac disease and endocrine autoimmunity – the genetic link. Autoimmun Rev. 2018. doi 10.1016/j.autrev.2018.05.013.
  5. Serena G, Camhi S, Sturgeon C, Yan S, Fasano A. The role of gluten in celiac disease and type 1 diabetes. Nutrients. 2015;7(9):7143–7162. doi 10.3390%2Fnu7095329.
  6. Morreale F, Agnoli C, Roncoroni L, et al. Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet? Nutr Metab Cardiovasc Dis. 2018. doi 10.1016/j.numecd.2018.06.021.
  7. Syage JA, Kelly CP, Dickason MA, et al. Determination of gluten consumption in celiac disease patients on a gluten-free diet. J Clin Nutrition. 2018;107(2):201–207. doi 10.1093/ajcn/nqx049.

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