400% Increase in Risk of Death for Undiagnosed Celiacs

Celiac.com 04/22/2009 - Not many studies have looked at prevalence and long-term outcome of undiagnosed celiac disease, and so not much is known about this aspect of the disease. Recently, a team of Mayo Clinic researchers conducted Open Original Shared Link, and whether the prevalence of undiagnosed celiac disease has changed during the past 50 years.

The research team was made up of Alberto Rubio-Tapia, MD; Robert A. Kyle, MD; Edward L. Kaplan, MD; Dwight R. Johnson, MD; William Page, PhD; Frederick Erdtmann, MD, MPH; Tricia L. Brantner, MD; W. Ray Kim, MD, Tara K. Phelps, MS; Brian D. Lahr, MS; Alan R. Zinsmeister, PhD; L. Joseph Melton III, MD; and Joseph A. Murray, MD.

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For the study the team looked at blood samples taken from 9,133 healthy young adults at Warren Air Force Base between 1948 and 1954, along with samples from 12,768 sex-matched subjects from 2 recent cohorts from Olmsted County, Minnesota. Subjects from the Minnesota cohorts were matched for date of birth (n=5,558) or age at sampling (n=7,210) with the Air Force study.

The research team tested the blood samples for tissue transglutaminase and, if abnormally high, for endomysial antibodies. They charted survival rates in a 45 year follow-up period in the Air Force and compared rates of undiagnosed celiac between the Air Force data and the recent cohorts.

Of 9,133 Air Force subjects, 14 had undiagnosed celiac disease--a rate of 0.2%. In that cohort, persons with undiagnosed celiac disease had higher mortality rates across the board than those who had tested negative (hazard ratio=3.9; 95% CI, 2.0-7.5; P <.001).

In the case of the Minnesota cohorts, the team found undiagnosed celiac disease in 68 persons with similar age at sampling (0.9%), and 46 persons with similar years of birth (0.8%). These recent cohorts showed rates of undiagnosed celiac disease that were 4.5-times and 4-times greater than the Air Force cohort (both P=.0001).

The research team found that data from the 45 year of follow-up of Air Force subjects showed that people with undiagnosed celiac disease have a 400% higher risk of death than seronegative subjects ("non-celiacs"). They also concluded that rates of undiagnosed celiac disease seem have increased dramatically in the United States over the last 50 years.

Gastroenterology - 13 April 2009 (10.1053/j.gastro.2009.03.059).