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  • Jefferson Adams
    Jefferson Adams

    High Incidence of Celiac Disease in a Long-term Study of Adolescents with Susceptibility Genotypes

    Caption: Photo: CC-- Gordon

    Celiac.com 03/20/2017 - Researchers really do not have really good data on rates of celiac disease in the general population of children in the United States. A team of researchers recently set out to estimate the cumulative incidence of celiac disease in adolescents born in the Denver metropolitan area.

    The research team included Edwin Liu, Fran Dong, MS, Anna E. Barón, PhD, Iman Taki, BS, Jill M. Norris, MPH, PhD, Brigitte I. Frohnert, MD, PhD, Edward J. Hoffenberg, MD, and Marian Rewers, MD, PhD.

    Their team collected data on HLA-DR, DQ genotypes of 31,766 infants, born from 1993 through 2004 at St. Joseph’s Hospital in Denver, from the Diabetes Autoimmunity Study in the Young. For up to 20 years, the researchers followed subjects with susceptibility genotypes for celiac disease and type 1 diabetes for development of tissue transglutaminase autoantibodies (tTGA).

    The team was looking for patients who developed either celiac disease autoimmunity (CDA) or celiac disease, and they defined CDA as persistence of tTGA for at least 3 months or development of celiac disease. Marsh 2 or greater lesions in biopsies or persistent high levels of tTGA, indicated celiac disease.

    For each genotype, the team assessed cumulative incidence of CDA and celiac disease. To estimate the cumulative incidence in the Denver general population, they weighted outcomes by each genotype, based on the frequency of each of these genotypes in the general population.

    They found that, of 1.339 patients they studied, 66 developed CDA and met criteria for celiac disease, while 46 developed only CDA. Seropositivity for tTGA resolved spontaneously, without treatment, in 21 of the 46 patients with only CDA (46%). The team estimated the total incidence for CDA in the Denver general population at 5, 10, and 15 years of age was 2.4%, 4.3%, and 5.1% respectively; incidence values for celiac disease were 1.6%, 2.8%, and 3.1%, respectively.

    This 20-year prospective study of 1.339 children with genetic risk factors for celiac disease showed the total incidence of CDA and celiac disease to be high within the first 10 years.

    Although more than 5% of children may experience a period of CDA, that is, persistently high celiac autoantibodies, not all of them develop celiac disease or require gluten-free diets.

    Sources:


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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    Celiac.com 10/09/2015 - For each the past three years, the FDA has sponsored a public workshop focusing on end points and clinical outcomes for drug development in GI diseases. The program is known as the Gastroenterology Regulatory Endpoints and the Advancement of Therapeutics, or by the acronym: GREAT.
    This year, GREAT 3, celiac disease was the focus. Experts addressed topics that included difficulties in assembling an appropriate target population for pharmacologic therapy, defining and measuring efficacy in clinical celiac disease trials, and the timing of assessment end points. One of the key points made during the conference concerned the special challenges for kids with celiac disease, including lower rates of compliance with a gluten-free diet.
    Alessio Fasano, MD, director of the Center for Celiac Research at MassGeneral Hospital for Children, in Boston, said that the data shows that only about 1 in 3 of adults with celiac disease are compliant with a gluten-free diet, with lower compliance in children. Because of this, he notes, "there is an even stronger need for pharmacologic therapies than in the pediatric population than in the adult population."
    Kids want to "fit in," says Dr. Fassano, and so providing "a pharmacologic safety net for children who want to attend a birthday party or sleepover, so that they do not have to worry about what they eat, could make a huge difference in their lives."
    College students are another high-risk group for noncompliance, and many campus cafeterias still struggle to provide safe gluten-free diets. He noted that although repeated endoscopies are recommended for monitoring celiac disease in adults, they are not advised in children.
    Overall, it seems that children and young people might be the main beneficiaries of drug treatments for celiac disease, though anyone with high sensitivity and a risk of gluten contamination would also likely benefit form such therapies.
    As a whole, the group in attendance seemed to be in agreement that, while much work remains to advance the treatment of celiac disease, researchers "know more about this inflammatory disease than virtually any other disease in the immune category. We should be able to come up with alternatives to a gluten-free diet."
    What do you think? Would you welcome an alternative to a gluten-free diet for your celiac disease? 
    Read more at: Gastrendonews.com

    Jefferson Adams
    New Study Takes a Deep Look at US Celiac Disease Rates Over Time
    Celiac.com 09/26/2016 - Previous studies have indicated an increase in celiac disease rates in the United States, but these studies have been done on narrow populations, and did not produce results that are nationally representative.
    Researchers recently released an new comprehensive report, called, Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014. The research team included Hyun-seok Kim, MD, MPH; Kalpesh G. Patel, MD1; Evan Orosz, DO; Neil Kothari, MD; Michael F. Demyen, MD; Nikolaos Pyrsopoulos, MD, PhD, MBA; and Sushil K. Ahlawat, MD. They are variously affiliated with the Division of Gastroenterology and the Department of Medicine at Rutgers New Jersey Medical School in Newark.
    Using data from the National Health and Nutrition Examination Surveys, a team of researchers recently examined current trends in both celiac disease rates, and gluten-free diet adherence.
    Currently, far more people follow a gluten-free diet than have celiac disease. The numbers of people eating gluten-free food far outpace the levels of celiac disease diagnosis. This may be due to perceptions that the diet is healthier than a standard non-gluten-free diet.
    This research teams recent surveys examine the current trends in the prevalence of celiac disease and adherence to a gluten-free diet, including people without celiac disease, using nationally representative data from the National Health and Nutrition Examination Surveys (NHANESs) 2009-2014.
    The study evaluated 22,278 individuals over the age of 6 who completed surveys and blood tests for celiac disease. The subjects were interviewed directly regarding their prior diagnosis of celiac disease and adherence to a gluten-free diet.

    The researchers found that 106 (0.69%) individuals had a celiac disease diagnosis, and 213 (1.08%) followed a gluten-free diet but didn't have celiac disease. These results correlate to an estimated 1.76 million people with celiac disease, and 2.7 million people who follow a gluten-free diet without a diagnosis of celiac disease in the United States.

    Overall, the researchers found that the prevalence of celiac disease has remained steady (0.70% in 2009-2010, 0.77% in 2011-2012, and 0.58% in 2013-2014), however, those who follow a gluten-free diet but don't have celiac disease have increased over time (0.52% in 2009-2010, 0.99% in 2011-2012, and 1.69% in 2013-2014). The researchers conclude that the two might be related, as the decrease in gluten consumption could contribute to a plateau in those who are being diagnosed with celiac disease.
    Source:
    JAMA Intern Med. Published online September 06, 2016. doi:10.1001/jamainternmed.2016.5254

    Jefferson Adams
    Can Anthropometric Measures and Prevalence Trends Tell Us About Adolescents with Celiac Disease?
    Celiac.com 01/04/2017 - A team of researchers recently set out to investigate the impact of celiac disease diagnosis on anthropometric measures at late adolescence, and to assess trends in the prevalence of diagnosed celiac disease over time.
    The research team included Amit Assa, Yael Frenkel-Nir, Ya'ara Leibovici-Weissman, Dorit Tzur, Arnon Afek, Lior H Katz, Zohar Levi, and Raanan Shamir. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach Tikva, Israel, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, the Medical Corps of the Israel Defense Forces, Ramat-Gan, Israel, the Institute of Gastroenterology, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel, and with the Ministry of Health in Jerusalem, Israel.
    Around 17 years of age, most of the Israeli Jewish population undergoes a general health examination, before enlistment in the Defense Forces. Individual medical information, diagnoses, etc., are entered into a structured database. For their population based study, the research team reviewed the enlistment data base for celiac disease cases between the years 1988 and 2015.
    In all, the team reviewed the medical records of 2,001,353 individuals, focusing on body measurements and physical health at the age of 17 years.
    Overall, they found and assessed 10,566 cases of celiac disease (0.53%). Multivariable analysis showed that adolescent boys with celiac disease were leaner (Body Mass Index 21.2±3.7 vs 21.7±3.8, p=0.02), while girls with celiac disease were shorter (161.5±6 cm vs 162.1±6 cm, p=0.017) than the general population.
    The prevalence of diagnosed celiac disease increased from 0.5% to 1.1% in the last 20 years, mainly among females, who saw a rise of 0.64% vs 0.46% for males. Celiac disease rates were far lower in people of lower socioeconomic status, and those of African, Asian and former Soviet Union origin.
    However, the clinical relevance of the small differences suggests that when celiac disease is diagnosed during childhood, final weight and height are not severely impaired.
    The team's cohort supports an observed rise in celiac disease diagnoses in the last couple of decades.
    Source:
    Arch Dis Child doi:10.1136/archdischild-2016-311376

    Jefferson Adams
    Less Hidden Celiac Disease, But More Americans Avoiding Gluten
    Celiac.com 01/20/2017 - A team of researchers recently investigated trends in the prevalence of diagnosed celiac disease, undiagnosed celiac disease, and people without celiac disease avoiding gluten (PWAG) in the civilian non-institutionalized US population from 2009 to 2014.
    The research team included Rok Seon Choung, MD, PhD, Aynur Unalp-Arida, MD, PhD, Constance E. Ruhl, MD, PhD, Tricia L. Brantner, BS, James E. Everhart, MD, and Joseph A. Murray, MD.
    They are variously affiliated with the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; the Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD; Social & Scientific Systems, Inc., Silver Spring, MD; and with the Division of Cancer Epidemiology and Genetics, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
    Their team studied the occurrence of celiac disease and PWAG in the 2009 to 2014 National Health and Nutrition Examination Surveys. They tested serum of all participants aged 6 years or older from the National Health and Nutrition Examination Surveys from 2009 to 2014 for celiac disease serology at Mayo Clinic.
    They also interviewed participants for a diagnosis of celiac disease, and the use of a gluten-free diet (GFD). They incorporated the design effects of the survey and sample weights into all statistical analyses.
    Results
    They found that, in the US general population, rates of celiac disease did not change significantly from 0.7% (95% CI, 0.6%-0.8%) in 2009 to 2010 to 0.8% (95% CI, 0.4%-1.2%) in 2011 to 2012 to 0.7% (95% CI, 0.3%-1.0%) in 2013 to 2014. However, rates of undiagnosed celiac disease decreased from 0.6% in 2009 to 2010 to 0.3% in 2013 to 2014.
    In contrast, the prevalence of PWAG increased significantly from 0.5% (95% CI, 0.2%-0.9%) in 2009 to 2010 to 1.0% (95% CI, 0.6%-1.4%) in 2011 to 2012 to 1.7% (95% CI, 1.1%-2.4%) in 2013 to 2014 (P=.005 for trend).
    Their data shows that, even though rates of celiac disease remained largely stable from 2009 to 2014, the percentage of individuals with hidden celiac disease decreased substantially.
    Moreover, the proportion of individuals who follow a gluten-free diet without celiac disease rose sharply during that period. Long-term health consequences of a GFD warrant further investigation.
    Source:
    Mayo Clinic Proceedings. DOI: http://dx.doi.org/10.1016/j.mayocp.2016.10.012

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