Title Association Between Celiac Disease and Iron Deficiency in Caucasians , but not Non-Caucasians Permalink

Background & Aims—Celiac disease is an increasingly recognized disorder in Caucasian populations of European origin. Little is known about its prevalence in non-Caucasians. Although © 2013 The American Gastroenterological Association. Published by Elsevier Inc. All rights reserved. Address for Correspondence: Joseph A Murray, MD, Division of Gastroenterology and Hepatology, Departments of Medicine and Immunology, The Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, Telephone: 507284 2631, Facsimile: 507-266-9081, murray.joseph@mayo.edu. CONFLICT OF INTEREST Guarantor of the article: Joseph A. Murray, MD. Substantial contributions to the study concept and design; conducted data analysis and data interpretation; critically revised the article: Stela McLachlan, Chad P. Garner Substantial contributions to the concept and design, as well as data acquisition, critically revised the article: Ronald T. Acton, Paul C. Adams, John H. Eckfeldt, Victor R. Gordeuk, Christine E. McLaren, Gordon D. McLaren Conducted data analysis; critically revised the article: Tricia Brantner, Catherine Leiendecker-Foster, Participated in data interpretation; critically revised the article: Lisa F. Barcellos, Kenneth B. Beckman, Antony A. Killeen, Deborah A Nickerson, Chris D. Vulpe All authors have approved the final revision Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Clin Gastroenterol Hepatol. Author manuscript; available in PMC 2014 July 01. Published in final edited form as: Clin Gastroenterol Hepatol. 2013 July ; 11(7): . doi:10.1016/j.cgh. 2013.02. 009. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript it is thought to be a cause of iron deficiency anemia, little is known about the extent to which celiac disease contributes to iron deficiency in Caucasians, and especially non-Caucasians. We analyzed samples collected from participants in the Hemochromatosis and Iron Overload Screening (HEIRS) study to identify individuals with iron deficiency and assess the frequency of celiac disease. METHODS—We analyzed serum samples from white men (25 y old or older) and women (50 y old or older) who participated the HEIRS study; cases were defined as individuals with iron deficiency (serum level of ferritin ≤12 mg/L) and controls were those without (serum level of ferritin >100 mg/L in men and >50 mg/L in women). All samples were also analyzed for human recombinant tissue transglutaminase immunoglobulin A; positive results were confirmed by an assay for endomysial antibodies. Patients with positive results from both celiac disease tests were presumed to have untreated celiac disease, and those with a positive result from only 1 test were excluded from analysis. We analyzed HLA genotypes and frequencies of celiac disease between Caucasians and non-Caucasians with iron deficiency. RESULTS—Celiac disease occurred in 14 of 567 of cases (2.5%) and in only 1 of 1136 controls (0.1%; Fisher’s exact test, P=1.92 × 10−6). Celiac disease was more common in Caucasian cases (14/363, 4%) than non-Caucasian cases (0/204; P=.003). Only 1 Caucasian control and no nonCaucasian controls had celiac disease. The odds of celiac disease in individuals with iron deficiency was 28-fold (95% confidence interval, 3.7–212.8) that of controls; 13/14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype. CONCLUSIONS—Celiac disease is associated with iron deficiency of Caucasians. Celiac disease is rare among non-Caucasians—even among individuals with features of celiac disease, such as iron deficiency. Celiac disease is also rare among individuals without iron deficiency. Men and post-menopausal women with iron deficiency should be tested for celiac disease.