Less hidden celiac disease but increased gluten avoidance without a diagnosis in the United States: findings from the National Health and Nutrition Examination Surveys from 2009 to 2014

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From: Mayo Clinic Proceedings(Vol. 92, Issue 1)
Publisher: Elsevier, Inc.
Document Type: Report
Length: 4,621 words
Lexile Measure: 1530L

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Objective: To investigate the trends in the prevalence of diagnosed celiac disease (CD), undiagnosed CD, and people without celiac disease avoiding gluten (PWAG) in the civilian noninstitutionalized US population from 2009 to 2014.

Patients and Methods: We studied the occurrence of CD and PWAG in the 2009 to 2014 National Health and Nutrition Examination Surveys. The serum of all participants aged 6 years or older from the National Health and Nutrition Examination Surveys from 2009 to 2014 was tested for CD serology at Mayo Clinic. Participants were interviewed for a diagnosis of CD and the use of a gluten-free diet (GFD). The design effects of the survey and sample weights were incorporated in all statistical analyses.

Results: In the US general population, the prevalence of CD 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, the prevalence of undiagnosed CD 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).

Conclusion: Although the overall prevalence of CD remained stable from 2009 to 2014, the proportion of individuals with CD that is hidden considerably decreased. Moreover, the proportion of individuals without CD but following a GFD increased markedly from 2009 to 2014. Long-term health consequences of a GFD warrant further investigation.


Celiac disease (CD) is an autoimmune disease that affects approximately 1% of the US population and amounts to a substantial public health burden. (1-3) Symptomatic (diagnosed) CD can be a devastating disease and is associated with increased mortality and substantial accumulated morbidity. (2,4) Until recently, most of what we knew about CD was based on studies of diagnosed CD. Although an increase in CD is documented worldwide, (2,5-7) we have found that even with modem clinical laboratory techniques of CD detection widely available, more than 80% of patients with CD remain undetected clinically. (3,8)

The gluten-free diet (GFD) is mainly considered to be the treatment for gluten-related conditions including CD and wheat allergy, (4) but was not widely used previously for other disorders. However, several studies (9-11) found that many people without CD are interested in following a GFD. The benefits of following a GFD in people without CD have not been tested rigorously, and indeed nutritional concerns have been raised about deficient iron, calcium, and fiber consumption. (12,13) In contrast to public interest in following a GFD, it remains uncertain whether there is any benefit of following a GFD for people without gluten-related conditions. (14) Nonetheless, recent public attention to the GFD has increased dramatically along with the market shares of nutraceutical products. (3,10,11,15-19) However, the real magnitude of this emerging public health issue and population-based prevalence of gluten-related conditions, including CD and people...

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Gale Document Number: GALE|A479714613