Skip to main content
Log in

Racial Differences in the Prevalence of Celiac Disease in the US Population: National Health and Nutrition Examination Survey (NHANES) 2009–2012

Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Aim

To provide an estimate of the prevalence of celiac disease by race/ethnic origin in large sample of US population.

Methods

Data from the 2009–2010 and 2011–2012 NHANES were combined and analyzed. The NHANES is a nationally representative survey with oversampling of certain minorities. Sample-based frequencies were reported and weighted frequencies were used to estimate prevalence.

Results

A total of 14,701 participants were checked for tissue transglutaminase (tTG) and endomysial (EMA) IgA antibodies. Seventy-four participants had positive tTG and/or EMA corresponding to prevalence of 0.79 % (95 % CI 0.54–1.04 %). Non-Hispanic white were more likely to be positive for both compared with other races (72.0 vs 31.7 %; p = 0.010) and less likely to be weakly positive for tTG but positive for EMA (3.6 vs 26.4 %; p = 0.03). The prevalence of positive serology according to race was as follows: 1.08 % (95 % CI 0.70–1.45 %) in non-Hispanic white, 0.23 % (95 % CI 0.03–0.43 %) in Mexican, 0.22 % (95 % CI 0.01–0.44 %) in non-Hispanic black, 0.38 % (95 % CI 0.00–0.89 %) in “other Hispanic,” and 0.15 % (95 % CI 0.00–0.34 %) in other races including multiracial and undeterminable in non-Hispanic Asian due to the presence of only one positive EMA test. 0.9 % of the NHANES sample participants followed gluten-free diet. Of this group of participants, 85 % were never diagnosed with celiac disease and 99 % of them had negative celiac disease serology.

Conclusions

Potentially 0.79 % of the general US population demonstrate serologic evidence of celiac disease autoimmunity. The prevalence is 4–8 times higher among non-Hispanic white compared with other races. Close to 1 % of the population is electively following gluten-free diet despite having little evidence of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Evans KE, Sanders DS. Celiac disease. Gastroenterol Clin N Am. 2012;41:639–650.

    Article  Google Scholar 

  2. Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26:1217–1225.

    Article  CAS  PubMed  Google Scholar 

  3. Ludvigsson JF, Rubio-Tapia A, van Dyke CT, et al. Increasing incidence of celiac disease in a North American population. Am J Gastroenterol. 2013;108:818–824.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Di Sabatino A, Corazza GR. Coeliac disease. Lancet. 2009;373:1480–1493.

    Article  PubMed  Google Scholar 

  5. Leffler DA, Schuppan D. Update on serologic testing in celiac disease. Am J Gastroenterol. 2010;105:2520–2524.

    Article  PubMed  Google Scholar 

  6. Fasano A, Berti I, Gerrarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163:286–292.

    Article  PubMed  Google Scholar 

  7. Rubio-Tapia A, Ludvigsson JF, Brantner TL, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107:1538–1544.

  8. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. http://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed October 03, 2014.

  9. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. Analytic Guidelines. http://www.cdc.gov/nchs/data/nhanes/analytic_guidelines_11_12.pdf. Accessed October 03, 2014.

  10. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. Laboratory Procedure Manual. Analyte: Tissue Transglutaminase Assay (IgA) http://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/TGEMA_F_met_.pdf. Accessed October 03, 2014.

  11. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. Laboratory Procedure Manual. Analyte: Endomysial Antibody Assay (EMA) http://www.cdc.gov/nchs/data/nhanes/nhanes_11_12/TGEMA_G_met_EMA.pdf. Accessed October 03, 2014.

  12. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62:43–52.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. Questionnaire data. http://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Questionnaire&CycleBeginYear=2011. Accessed October 03, 2014.

  14. United States Census Bureau. 2010 Census Shows America’s Diversity. http://www.census.gov/newsroom/releases/archives/2010_census/cb11-cn125.html. Accessed October 03, 2014.

  15. Talley NJ, Valdovinos M, Petterson TM, et al. Epidemiology of celiac sprue: a community-based study. Am J Gastroenterol. 1994;89:843–846.

    CAS  PubMed  Google Scholar 

  16. Murray JA, Van Dyke C, Plevak MF, et al. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastroenterol Hepatol. 2003;1:19–27.

    Article  PubMed  Google Scholar 

  17. West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut. 2003;52:960–965.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137:88–93.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Catassi C, Kryszak D, Bhatti B, et al. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med. 2010;42:530–538.

    Article  PubMed  Google Scholar 

  20. Kang JY, Kang AH, Green A, et al. Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment Pharmacol Ther. 2013;38:226–245.

    Article  CAS  PubMed  Google Scholar 

  21. Remes-Troche JM, Ramírez-Iglesias MT, Rubio-Tapia A, et al. Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors. J Clin Gastroenterol. 2006;40:697–700.

    Article  PubMed  Google Scholar 

  22. Sher KS, Fraser RC, Wicks AC, et al. High risk of coeliac disease in Punjabis. Epidemiological study in the south Asian and European populations of Leicestershire. Digestion. 1993;54:178–182.

    Article  CAS  PubMed  Google Scholar 

  23. Ji J, Ludvigsson JF, Sundquist K, et al. Incidence of celiac disease among second-generation immigrants and adoptees from abroad in Sweden: evidence for ethnic differences in susceptibility. Scand J Gastroenterol. 2011;46:844–848.

    Article  PubMed  Google Scholar 

  24. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. Racial and ethnic minority populations. http://www.cdc.gov/minorityhealth/populations/REMP/definitions.html.

  25. Rubio-Tapia A, Hill ID, Kelly CP, et al. American College of Gastroenterology Clinical Guideline: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108:656–677.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Hischenhuber C, Crevel R, Jarry B, et al. Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease. Aliment Pharmacol Ther. 2006;23:559–575.

    Article  CAS  PubMed  Google Scholar 

  27. Leffler D, Schuppan D, Pallav K, et al. Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease. Gut. 2013;62:996–1004.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors report no conflict of interest or financial support relevant to this work. All authors approved the final version of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Houssam E. Mardini.

Additional information

Houssam E. Mardini and Philip Westgate have contributed equally to this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mardini, H.E., Westgate, P. & Grigorian, A.Y. Racial Differences in the Prevalence of Celiac Disease in the US Population: National Health and Nutrition Examination Survey (NHANES) 2009–2012. Dig Dis Sci 60, 1738–1742 (2015). https://doi.org/10.1007/s10620-014-3514-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3514-7

Keywords

Navigation