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Celiac disease may vary by ethnicity, study suggests

1 commentBy Caroline Scott-Thomas , 17-Aug-2012
Last updated on 17-Aug-2012 at 15:10 GMT

Celiac disease may vary by ethnicity, study suggests

Prevalence of celiac disease in the United States may vary by ethnicity, with the highest prevalence among non-Hispanic whites, according to a new study published in The American Journal of Gastroenterology.

Researchers from the Mayo Clinic examined blood tests from a nationally representative sample of nearly 8,000 individuals and found markers for celiac disease in 35 participants, or 0.71% of the total sample. They then combined these results with interviews from the National Health and Nutrition Examination Survey (NHANES). Twenty-nine of the 35 subjects suspected to have celiac disease previously had not been diagnosed with the disorder.

"Virtually all the individuals we found were non-Hispanic Caucasians," said co-author of the study Alberto Rubio-Tapia, a Mayo Clinic gastroenterologist. He added that previous research in Mexico has suggested celiac disease there could be just as common as it is in the United States.

"So that is something we don't fully understand," he said.

Celiac disease is an autoimmune disorder with symptoms triggered by consumption of gluten, the protein in wheat, barley, rye and spelt. Currently the only available treatment is complete dietary avoidance of gluten.

The prevalence of those on a gluten-free diet was highest among female adults, but not among non-Hispanic whites – although non-Hispanic whites accounted for 29 of the 35 cases of suspected celiac disease.

Gluten-free diets

About 80% of those on gluten-free diets had not been diagnosed with the disorder.

"There are a lot of people on a gluten-free diet, and it's not clear what the medical need for that is," said study co-author Joseph Murray, also a Mayo Clinic gastroenterologist. "It is important if someone thinks they might have celiac disease that they be tested first before they go on the diet."

The market for gluten-free products has grown faster than expected in recent years, driven by increased diagnosis of celiac disease, a growing market of individuals with abdominal or intestinal symptoms that they manage with a gluten-free diet, and those who choose gluten-free products because they believe them to be healthier. Market research organization Packaged Facts valued the market at $2.64bn in 2010 – a compound annual growth rate (CAGR) of 30% from 2006 to 2010.

Prevalence

Extrapolating their data to the US population as a whole, the researchers suggested that celiac disease could affect about 1 in every 141 people in the United States, but about 1 in 100 non-Hispanic whites. Overall, their results suggest a similar prevalence of celiac disease in the US as in Europe.

The researchers acknowledged that their study was limited by their use of blood tests, rather than intestinal biopsy, the accepted method for diagnosing celiac disease. They said that performing an invasive procedure such as intestinal biopsy has historically led to high non-participation rates, making it unfeasible for gathering data from large groups of individuals.

Gluten-free nutrition

Dietitians previously have suggested that many celiac diets are low in nutrients, particularly fiber and iron, as manufacturers have often relied on combinations of rice flour, corn starch, potato starch and tapioca starch for gluten-free formulations. However, manufacturers have increasingly moved beyond these relatively nutrient-poor ingredients toward other, more nutrient-rich ingredients, such as mesquite flour, millet, nut flours, pulse flours, sorghum, soy, and teff.

Meanwhile, Packaged Facts predicts that the market for gluten free foods will continue to grow over the next several years, albeit at a slower rate, and now projects the US market for gluten-free foods to approach $5.5bn by 2015.

 

Source: The American Journal of Gastroenterology

doi: 10.1038/ajg.2012.219

“The Prevalence of Celiac Disease in the United States”

Authors: Alberto Rubio-Tapia, Jonas F. Ludvigsson, Tricia L. Brantner, Joseph A. Murray, and James E. Everhart

1 comment (Comments are now closed)

My child was 1 of the USA's diagnosed 3%

I consider it a bittersweet blessing my daughter was finally diagnosed at "15". If her extremely healthy father hadn't required a 'feeding tube', due to being 'comatose' as the result of brain injury from a cardiac arrest at age 41 she may never have been. Though we were upper middle class Americans and she had the BEST physicians available, no one could understand WHY she developed kidney stones at age "11", often awakened at 2,3,4:00 am to vomit, constantly complained of being constipated, bloated, having a "tummy ache", etc...
It took STRESS and a Harvard/Yale trained Gastro-enterologist that LISTENED to my child to diagnose this illness. Less than one year after "Dad" got sick, while caring for him at home, the vomiting became more frequent and the duration lasted longer, up to 8,10, 12 hours. The only way to stop it was a trip to the Emergency Room where she rec'd IV fluids and a drug called "Zofran". Yet, NO ONE could explain "WHY" my child continued to vomit more often.

At a visit to have my ;ate spouse's feeding tube checked I asked the Dr. if he would see my child. The answer was, "....No, I really can't...this practice is adults only..I don't treat Pediatric patients..." Upon leaving I asked, really begged him to at least see her for one office visit (knowing he had 2 daughters of his own, similar in age). He agreed, probably to shut me up.
Upon examination he said, "..I believe I know exactly what's wrong with your daughter, but I want to run some more tests and BIOPSY her intestines..upper and lower..." FINE!!! :)
The results: CELIAC DISEASE
The following year we had genetic tests performed, and as I thought, I gave her the gene (I have Rheumatoid Arthritis and other auto-immune diseases). Although I don't have Celiac Disease, at present, I can become "full blown" at any moment. I am sensitive to adhesives containing 'gluten', and a few other things.
By chance we traced the gene back to my late father's side of the family. I was 18 months old when he died at age "36". I always believed his death resulted from "pancreatitis" due to ruptured stomach ulcers, and other problems that arose after taking a bullet to the chest at Iwo Jima. Now, I truly believe undiagnosed CELIAC DISEASE played a role in his death.

It seems we learn of more symptoms daily. My daughter's skin infection that occurred during her freshman year at college took 9 months to get under control. Then, it cost $2500.00 to have lazer surgery to remove the pitting and scarring from the affected portions of her legs. An additional $1000 to $1500.00 had already been spent on "fade cream" prior to the surgery. Blue Cross/Blue Shield (Federal Employee) Ins. CO. refused
to pay for any of the expenses except for the 9 months of antibiotics, stating the fade cream and lazer surgery were simply cosmetic procedures and unnecessary. She still requires lazer surgery on her face, upper back,neck, and both arms and shoulders (from the elbow up) to remove the remainder of scarring.

The scariest of all was when she would phone home after eating breakfast (12 hours away) and say, "...Mom I just ate and something's wrong...I feel drunk...." The 'cross-contamination' episodes lasted approx. 24-36 hours, affected her skin, her BRAIN, damaged both upper and lower intestines (AGAIN), and had created lesions on her esophagus and inside the stomach.
YES, we had 3 interviews with the Executive chef and staff prior to accepting the FULL SCHOLARSHIP offer at this $50,000 per year college. We were told emphatically they had "7" CELIACS attending in the fall, and had been feeding CELIACS for years. As a matter of fact this well known university prided themselves on being ranked among the top 10 schools in their ability and willingness to reach out and accommodate students with "Disabilities". (This is considerate a 'disability', in this case."

Lesson learned. Her GPA took a nose dive. She stayed home the following year to heal and have the surgeries, while attending the local community college. Yet she remained so sick for so long it was a tremendous struggle to get her GPA number back up. Community service? Out of the question.

Bittersweet???? How? The stress from her father's cardiac arrest and the resulting 33 months of watching him lie comatose, in our home, prior to finally going 'home', exacerbated her symptoms to the point that a physician FINALLY took her seriously and a proper diagnosis was made. It even explained why she developed kidney stones at age 11. Her father's illness saved her from many additional years of suffering, and possibly death.
Even with the diagnosis, and the disease completely under control, she began to vomit the day following his death and it persisted for 10+ hours. Her 'melt on the tongue' ZOFRAN didn't work because the "stress" was simply too much for her body to manage.At which point, off to the hospital emergency room we went, yet again.
God works in mysterious ways.

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Posted by K. Smith
02 November 2012 | 01h55

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