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

Rok Seon Choung, Aynur Unalp-Arida, Constance E. Ruhl, Tricia L. Brantner, James E. Everhart, Joseph A Murray

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalMayo Clinic Proceedings
Volume92
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Glutens
Nutrition Surveys
Celiac Disease
Gluten-Free Diet
Serology
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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. / Choung, Rok Seon; Unalp-Arida, Aynur; Ruhl, Constance E.; Brantner, Tricia L.; Everhart, James E.; Murray, Joseph A.

In: Mayo Clinic Proceedings, Vol. 92, No. 1, 01.01.2017, p. 30-38.

Research output: Contribution to journalArticle

@article{8b1ab0d9b17647cc8b7c74223fdd6357,
title = "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",
abstract = "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.",
author = "Choung, {Rok Seon} and Aynur Unalp-Arida and Ruhl, {Constance E.} and Brantner, {Tricia L.} and Everhart, {James E.} and Murray, {Joseph A}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.mayocp.2016.10.012",
language = "English (US)",
volume = "92",
pages = "30--38",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "1",

}

TY - JOUR

T1 - Less Hidden Celiac Disease But Increased Gluten Avoidance Without a Diagnosis in the United States

T2 - Findings From the National Health and Nutrition Examination Surveys From 2009 to 2014

AU - Choung, Rok Seon

AU - Unalp-Arida, Aynur

AU - Ruhl, Constance E.

AU - Brantner, Tricia L.

AU - Everhart, James E.

AU - Murray, Joseph A

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85009091502&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009091502&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2016.10.012

DO - 10.1016/j.mayocp.2016.10.012

M3 - Article

AN - SCOPUS:85009091502

VL - 92

SP - 30

EP - 38

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 1

ER -