Micronutrient Deficiencies Are Common in Contemporary Celiac Disease Despite Lack of Overt Malabsorption Symptoms

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From: Mayo Clinic Proceedings(Vol. 94, Issue 7)
Publisher: Elsevier, Inc.
Document Type: Clinical report
Length: 4,058 words
Lexile Measure: 1620L

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Objective: To evaluate micronutrient deficiencies in a contemporary cohort of adult patients with newly diagnosed celiac disease (CD).

Patients and Methods: This is a retrospective study of prospective adults newly diagnosed with CD from January 1, 2000, through October 31, 2014, at Mayo Clinic. Micronutrient data were collected for tissue transglutaminase IgA, zinc, 25-hydroxy vitamin D, ferritin, albumin, copper, vitamin [B.sub.12]> and serum folate. Data were analyzed for absolute number of deficiencies and associations with age, sex, body mass index, presenting symptoms, and tissue transglutaminase IgA; each deficiency was assessed using logistic regression. Deficiencies were compared with age- and sex-matched controls from the National Health and Nutrition Examination Survey.

Results: In total, 309 patients with CD (196 women and 113 men; mean age, 46.1 [+ or -] 15.1 years; mean body mass index, 25.9 kg/[m.sup.2]) were included. Weight loss was seen in only 25.2% (78/309) of patients. Zinc was deficient in 59.4% (126/212) of patients with CD compared with 33.2% (205/618) of controls (P<.001). Albumin was low in 19.7% (24/122) compared with 1.1% of controls (P<.001). Copper was low in 6.4% (13/204) compared with 2.1% (13/618) of controls (P=.003). Vitamin [B.sub.12] was low in 5.3% (13/244) compared with 1.8% (11/618) of controls (P=.004). Folate was low in 3.6% (6/159) compared with 0.3% (2/618) of controls (P=.002). 25-Hydroxy vitamin D was low in 19.0% (44/213) compared with 18% (111/618) of controls (P=.72). Ferritin was low in 30.8% (66/214) of patients; no NHANES controls were available for comparison for ferritin.

Conclusion: Micronutrient deficiencies remain common in adults with CD despite increased nonclassic presentation. This study provides support for micronutrient assessment at the time of CD diagnosis.


Celiac disease (CD) is a small bowel enteropathy occurring in genetically susceptible patients in response to ingested gluten. (1) Based on recent data from the National Health and Nutrition Examination Survey (NHANES), the weighted prevalence of CD in the United States is 0.7%, with 0.97% for non-Hispanic whites, 0.71% for those 18 years and older, and increased prevalence at higher northern latitudes. (2,3) Furthermore, the prevalence of CD has increased over the past 50 years. (4,5) The change in prevalence seems to be a change in presentation, with fewer contemporary patients presenting with macronutrient malnutrition (weight loss) and diarrhea. (6)

Recent guidelines on the diagnosis and management of CD recommend testing for nutrient deficiencies at the time of new diagnosis, and this assessment should include vitamin D, iron, folic acid, and vitamin [B.sub.12]. (7) These recommendations have been based on previous studies describing micronutrient deficiencies in adults and children with CD. Historically, data on micronutrient assessment have been published in Europe, with less data known from the United States. One large study in Italy evaluated more than 1000 adults and children (older than 14 years) and found low ferritin in 50%, low vitamin [B.sub.12] in 6.6%, and low folate in 73.8%, correlating these results with the degree of villous atrophy. (8) Another study of 93 adults with CD in Denmark found 30% of patients anemic,...

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Gale Document Number: GALE|A596467958