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  • Jefferson Adams
    Jefferson Adams

    What are the Rates and Risk of Celiac Disease in Healthy U.S. Adults?

    Reviewed and edited by a celiac disease expert.

    Celiac.com 08/06/2012 - Celiac disease seems to be on the rise in the United States, with recent population-based data suggest a sharp increase in rates over the last several decades.

    A number of researchers hypothesize that such a rise might be due in part to disease triggers including inter-current illnesses, such as gastroenteritis, surgeries, and trauma.

    Photo: CC--Ed YourdonBut just how common is celiac disease among the healthy adult population, and what, if any, do prior illnesses have to do with it? To get a better idea of actual rates and connections, a team of researchers recently conducted a study regarding the incidence and risk of celiac disease in healthy U.S. adults.

    The research team included Mark S. Riddle, Joseph A. Murray and Chad K. Porter. For their study, they turned to data from active duty US military personnel, a largely healthy population with excellent medical diagnostic coding. The data offered a unique opportunity to spot trends in celiac disease and deployment-related risk factors.

    The team used electronic medical encounter data, from 1999–2008, on active duty US military personnel. In all, they reviewed data for over 13.7 million person-years, to conduct a matched, nested case–control study describing the epidemiology and risk determinants of celiac disease (based on ≥2 ICD-9 medical encounters).

    Using this data, they were able to estimate incidence and duration of celiac-related medical care, and to employ conditional logistic regression to evaluate celiac disease risk following infectious gastroenteritis (IGE) up to 3 years before celiac diagnosis, while controlling for other risk factors.

    They found a total of 455 incident cases of celiac disease, which they then age, gender, and time matched to 1,820 control subjects.

    They found that, from 1999 to 2008, cases of celiac disease increased five-fold from 1.3 per 100,000 to 6.5 per 100,000, with the highest rates of increase among those over 34 years of age. The average annual increase was 0.8 cases per 100,000.

    They found a total of 172 episodes of IGE, 60.5% of which were viral in nature.

    Using multivariate models, they found a strong association between IGE and celiac disease was found (Odds ratio (OR): 2.06, 95% confidence interval (CI) 1.43, 2.97). Risk generally increased with temporal proximity to, and non-viral etiology of, exposure.

    Other notable risk factors for celiac disease in multivariate models were Caucasian race (OR: 3.1, P).

    Rates of celiac disease in the US military are rising, particularly among those in the fourth and fifth decades of life and the rates seem higher than other population-based estimates.

    The team noted a connection between prior IGE and risk of celiac disease, but they noted that they could not rule out possible IGE misclassification, and called for further study to better determine any links between pathogen-specific exposure to celiac disease, anti-gluten antibody development or symptom onset.

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    They can declare "healthy" person, when there is no reliable test for gluten sensitivity. I am lost there! I am on gluten-free diet, however, I do not consider myself sick. Why they call it disease? Anyway, testing keep doctors busy; despite the fact that is no way to rule out gluten sensitivity.

    Any argument? I don't think so!

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    Guest Wayne C. Boswell

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    We cannot establish a valid rate on the basis of just those who happen to be lucky enough to at some point be properly diagnosed. I was diagnosed at age 47, but in retrospect I realized the condition had plagued me my entire life... including a 4 year hitch in the U.S. NAVY. I read somewhere shortly after my way-late diagnosis that in Italy, children are tested for celiac sprue when they start school. Sure you say... the condition is much more prevalent in Europe. Hey! We nearly all have a heredity line from Europe. Most U.S. celiacs go undiagnosed for decades, while the auto-immune reactions are slowly destroying their health. Yes, it gets my goat!

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He 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 science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF 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.

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