title: Undiagnosed coeliac disease and nutritional deficiencies in adults screened in primary health care.
abstract: OBJECTIVE
  To compare the nutritional parameters of individuals with a previous diagnosis of coeliac disease (CD) with those of screen-detected patients in a large cohort of adults in primary care.
  
  
  METHODS
  A cohort of 1900 adults (aged 18-64 years) was screened for tissue transglutaminase antibodies (TG2A) in primary care in the capital region of Finland. IgA-endomysium antibodies (EmA), HLADQ2/8 associated with CD were determined in positive individuals. Folate, iron, and transferrin receptor in sera were assessed in patients reporting a previous diagnosis of CD and patients positive for the above tests.
  
  
  RESULTS
  Twenty-two out of 1900 (1%) patients reported a previous diagnosis of CD (biopsy-based 16/22 cases; 6/22 cases diagnostic criteria unknown). Among the screen-detected cases with TG2A> or = the cut-off value, 14/32 cases were considered to have CD based on high levels of both TG2A and EmA, DQ2/8 genotype and/or biopsy results. The prevalence of CD was as high as 1:53 in the total study population (36/1900), and in women even 1:46 (2.2%). Nutritional deficiencies were rare among CD patients diagnosed earlier (low iron = 1; low folate n=1) but common among those who had an undiagnosed CD (low folate n=6; p<0.005; concomitant iron deficiency n=2). One-third of the screen-detected CD patients were obese. Screen-detected patients did not present more abdominal symptoms than those with no CD.
  
  
  CONCLUSIONS
  CD is common, the proportion among women possibly being as high as 2.2%. Although the great majority of screen-detected patients do not present any gastrointestinal symptoms at primary care, nutritional deficiencies such as low folate levels and iron deficiency are common.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Tikkakoski
authors.forename: Erkki
authors.initials: E
authors.lastname: Savilahti
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005492:Folic Acid / Q000032:analysis; D019204:GTP-Binding Proteins; D006683:HLA-DQ Antigens / Q000032:analysis; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007501:Iron / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D011320:Primary Health Care; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011621:Pteridines / Q000032:analysis; D011990:Receptors, Transferrin / Q000032:analysis; D011503:Transglutaminases / Q000032:analysis
chemical_list: D001323:Autoantibodies; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen; D007070:Immunoglobulin A; D011621:Pteridines; D011990:Receptors, Transferrin; D005492:Folic Acid; C041669:biolumazine; D007501:Iron; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins