Association between celiac disease and iron deficiency in caucasians, but not non-caucasians

Joseph A. Murray; Stela McLachlan; Paul C. Adams; John H Eckfeldt; Chad P. Garner; Chris D. Vulpe; Victor R. Gordeuk; Tricia Brantner; Catherine Leiendecker-Foster; Anthony Killeen; Ronald T. Acton; Lisa F. Barcellos; Debbie A. Nickerson; Kenny B Beckman; Gordon D. McLaren; Christine E. McLaren

doi:10.1016/j.cgh.2013.02.009

Association between celiac disease and iron deficiency in caucasians, but not non-caucasians

Joseph A. Murray, Stela McLachlan, Paul C. Adams, John H Eckfeldt, Chad P. Garner, Chris D. Vulpe, Victor R. Gordeuk, Tricia Brantner, Catherine Leiendecker-Foster, Anthony Killeen, Ronald T. Acton, Lisa F. Barcellos, Debbie A. Nickerson, Kenny B Beckman, Gordon D. McLaren, Christine E. McLaren

Research output: Contribution to journal › Article › peer-review

32 Scopus citations

Abstract

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 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 study to identify individuals with iron deficiency and to assess the frequency of celiac disease. METHODS: We analyzed serum samples from white men (>25 y) and women (>50 y) who participated in the Hemochromatosis and Iron Overload Screening study; cases were defined as individuals with iron deficiency (serum ferritin level, >12 μg/L) and controls were those without (serum ferritin level, >100μg/L in men and >50 = g/L in women). All samples also were 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 cases (2.5%) and in only 1 of 1136 controls (0.1%; Fisher exact test, P = 1.92*10-6). Celiac disease was more common in Caucasian cases (14 of 363; 4%) than non-Caucasian cases (0 of 204; P ± .003). Only 1 Caucasian control and no non-Caucasian 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 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype. CONCLUSIONS: Celiac disease is associated with iron deficiency in Caucasians. Celiac disease is rare among non-Caucasians-even among individuals with features of celiac disease, such as iron deficiency. Celiac disease also is rare among individuals without iron deficiency. Men and postmenopausal women with iron deficiency should be tested for celiac disease.

Original language	English (US)
Pages (from-to)	808-814
Number of pages	7
Journal	Clinical Gastroenterology and Hepatology
Volume	11
Issue number	7
DOIs	https://doi.org/10.1016/j.cgh.2013.02.009
State	Published - Jul 2013

Bibliographical note

Funding Information:
Funding Support was provided by grant R01 HL083328 from the National Heart, Lung, and Blood Institute (C.E.M.). The Hemochromatosis and Iron Overload Screening study was initiated and funded by the National Heart, Lung, and Blood Institute, in conjunction with the National Human Genome Research Institute. Data collection for this study was supported by contracts N01-HC-05185 ( University of Minnesota ), N01-HC-05186 ( Howard University ), N01-HC-05188 ( University of Alabama at Birmingham ), N01-HC-05189 ( Kaiser Permanente Center for Health Research ), N01-HC-05190 ( University of California , Irvine), N01-HC-05191 ( London Health Sciences Centre ), and N01-HC-05192 ( Wake Forest University ). Additional funding was provided by the University of Alabama at Birmingham General Clinical Research Center ( M01-RR00032 ), Southern Iron Disorders Center (J.C.B.), Howard University General Clinical Research Center ( M01-RR10284 ), a Howard University Research Scientist Award ( UH1-HL03679-05 ) from the National Heart, Lung, and Blood Institute and the Office of Research on Minority Health (V.R.G.), grant UC Irvine M01RR 00827-29 from the General Clinical Research Centers Program of the National Center for Research Resources National Institutes of Health , and a Merit Review grant from the Department of Veterans Affairs (G.D.M.).

Keywords

Absorption
Gluten Allergy
Intestine
Risk Factor
SNP

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Murray, J. A., McLachlan, S., Adams, P. C., Eckfeldt, J. H., Garner, C. P., Vulpe, C. D., Gordeuk, V. R., Brantner, T., Leiendecker-Foster, C., Killeen, A., Acton, R. T., Barcellos, L. F., Nickerson, D. A., Beckman, K. B., McLaren, G. D., & McLaren, C. E. (2013). Association between celiac disease and iron deficiency in caucasians, but not non-caucasians. Clinical Gastroenterology and Hepatology, 11(7), 808-814. https://doi.org/10.1016/j.cgh.2013.02.009

Murray, JA, McLachlan, S, Adams, PC, Eckfeldt, JH, Garner, CP, Vulpe, CD, Gordeuk, VR, Brantner, T, Leiendecker-Foster, C, Killeen, A, Acton, RT, Barcellos, LF, Nickerson, DA, Beckman, KB, McLaren, GD & McLaren, CE 2013, 'Association between celiac disease and iron deficiency in caucasians, but not non-caucasians', Clinical Gastroenterology and Hepatology, vol. 11, no. 7, pp. 808-814. https://doi.org/10.1016/j.cgh.2013.02.009

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title = "Association between celiac disease and iron deficiency in caucasians, but not non-caucasians",

abstract = "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 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 study to identify individuals with iron deficiency and to assess the frequency of celiac disease. METHODS: We analyzed serum samples from white men (>25 y) and women (>50 y) who participated in the Hemochromatosis and Iron Overload Screening study; cases were defined as individuals with iron deficiency (serum ferritin level, >12 μg/L) and controls were those without (serum ferritin level, >100μg/L in men and >50 = g/L in women). All samples also were 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 cases (2.5%) and in only 1 of 1136 controls (0.1%; Fisher exact test, P = 1.92*10-6). Celiac disease was more common in Caucasian cases (14 of 363; 4%) than non-Caucasian cases (0 of 204; P ± .003). Only 1 Caucasian control and no non-Caucasian 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 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype. CONCLUSIONS: Celiac disease is associated with iron deficiency in Caucasians. Celiac disease is rare among non-Caucasians-even among individuals with features of celiac disease, such as iron deficiency. Celiac disease also is rare among individuals without iron deficiency. Men and postmenopausal women with iron deficiency should be tested for celiac disease.",

keywords = "Absorption, Gluten Allergy, Intestine, Risk Factor, SNP",

author = "Murray, {Joseph A.} and Stela McLachlan and Adams, {Paul C.} and Eckfeldt, {John H} and Garner, {Chad P.} and Vulpe, {Chris D.} and Gordeuk, {Victor R.} and Tricia Brantner and Catherine Leiendecker-Foster and Anthony Killeen and Acton, {Ronald T.} and Barcellos, {Lisa F.} and Nickerson, {Debbie A.} and Beckman, {Kenny B} and McLaren, {Gordon D.} and McLaren, {Christine E.}",

note = "Funding Information: Funding Support was provided by grant R01 HL083328 from the National Heart, Lung, and Blood Institute (C.E.M.). The Hemochromatosis and Iron Overload Screening study was initiated and funded by the National Heart, Lung, and Blood Institute, in conjunction with the National Human Genome Research Institute. Data collection for this study was supported by contracts N01-HC-05185 ( University of Minnesota ), N01-HC-05186 ( Howard University ), N01-HC-05188 ( University of Alabama at Birmingham ), N01-HC-05189 ( Kaiser Permanente Center for Health Research ), N01-HC-05190 ( University of California , Irvine), N01-HC-05191 ( London Health Sciences Centre ), and N01-HC-05192 ( Wake Forest University ). Additional funding was provided by the University of Alabama at Birmingham General Clinical Research Center ( M01-RR00032 ), Southern Iron Disorders Center (J.C.B.), Howard University General Clinical Research Center ( M01-RR10284 ), a Howard University Research Scientist Award ( UH1-HL03679-05 ) from the National Heart, Lung, and Blood Institute and the Office of Research on Minority Health (V.R.G.), grant UC Irvine M01RR 00827-29 from the General Clinical Research Centers Program of the National Center for Research Resources National Institutes of Health , and a Merit Review grant from the Department of Veterans Affairs (G.D.M.). ",

year = "2013",

month = jul,

doi = "10.1016/j.cgh.2013.02.009",

language = "English (US)",

volume = "11",

pages = "808--814",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Association between celiac disease and iron deficiency in caucasians, but not non-caucasians

AU - Murray, Joseph A.

AU - McLachlan, Stela

AU - Adams, Paul C.

AU - Eckfeldt, John H

AU - Garner, Chad P.

AU - Vulpe, Chris D.

AU - Gordeuk, Victor R.

AU - Brantner, Tricia

AU - Leiendecker-Foster, Catherine

AU - Killeen, Anthony

AU - Acton, Ronald T.

AU - Barcellos, Lisa F.

AU - Nickerson, Debbie A.

AU - Beckman, Kenny B

AU - McLaren, Gordon D.

AU - McLaren, Christine E.

N1 - Funding Information: Funding Support was provided by grant R01 HL083328 from the National Heart, Lung, and Blood Institute (C.E.M.). The Hemochromatosis and Iron Overload Screening study was initiated and funded by the National Heart, Lung, and Blood Institute, in conjunction with the National Human Genome Research Institute. Data collection for this study was supported by contracts N01-HC-05185 ( University of Minnesota ), N01-HC-05186 ( Howard University ), N01-HC-05188 ( University of Alabama at Birmingham ), N01-HC-05189 ( Kaiser Permanente Center for Health Research ), N01-HC-05190 ( University of California , Irvine), N01-HC-05191 ( London Health Sciences Centre ), and N01-HC-05192 ( Wake Forest University ). Additional funding was provided by the University of Alabama at Birmingham General Clinical Research Center ( M01-RR00032 ), Southern Iron Disorders Center (J.C.B.), Howard University General Clinical Research Center ( M01-RR10284 ), a Howard University Research Scientist Award ( UH1-HL03679-05 ) from the National Heart, Lung, and Blood Institute and the Office of Research on Minority Health (V.R.G.), grant UC Irvine M01RR 00827-29 from the General Clinical Research Centers Program of the National Center for Research Resources National Institutes of Health , and a Merit Review grant from the Department of Veterans Affairs (G.D.M.).

PY - 2013/7

Y1 - 2013/7

N2 - 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 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 study to identify individuals with iron deficiency and to assess the frequency of celiac disease. METHODS: We analyzed serum samples from white men (>25 y) and women (>50 y) who participated in the Hemochromatosis and Iron Overload Screening study; cases were defined as individuals with iron deficiency (serum ferritin level, >12 μg/L) and controls were those without (serum ferritin level, >100μg/L in men and >50 = g/L in women). All samples also were 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 cases (2.5%) and in only 1 of 1136 controls (0.1%; Fisher exact test, P = 1.92*10-6). Celiac disease was more common in Caucasian cases (14 of 363; 4%) than non-Caucasian cases (0 of 204; P ± .003). Only 1 Caucasian control and no non-Caucasian 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 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype. CONCLUSIONS: Celiac disease is associated with iron deficiency in Caucasians. Celiac disease is rare among non-Caucasians-even among individuals with features of celiac disease, such as iron deficiency. Celiac disease also is rare among individuals without iron deficiency. Men and postmenopausal women with iron deficiency should be tested for celiac disease.

AB - 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 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 study to identify individuals with iron deficiency and to assess the frequency of celiac disease. METHODS: We analyzed serum samples from white men (>25 y) and women (>50 y) who participated in the Hemochromatosis and Iron Overload Screening study; cases were defined as individuals with iron deficiency (serum ferritin level, >12 μg/L) and controls were those without (serum ferritin level, >100μg/L in men and >50 = g/L in women). All samples also were 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 cases (2.5%) and in only 1 of 1136 controls (0.1%; Fisher exact test, P = 1.92*10-6). Celiac disease was more common in Caucasian cases (14 of 363; 4%) than non-Caucasian cases (0 of 204; P ± .003). Only 1 Caucasian control and no non-Caucasian 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 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype. CONCLUSIONS: Celiac disease is associated with iron deficiency in Caucasians. Celiac disease is rare among non-Caucasians-even among individuals with features of celiac disease, such as iron deficiency. Celiac disease also is rare among individuals without iron deficiency. Men and postmenopausal women with iron deficiency should be tested for celiac disease.

KW - Absorption

KW - Gluten Allergy

KW - Intestine

KW - Risk Factor

KW - SNP

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Association between celiac disease and iron deficiency in caucasians, but not non-caucasians

Abstract

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