title: Morbidity and mortality among older individuals with undiagnosed celiac disease.
abstract: OBJECTIVE
  Outcomes of undiagnosed celiac disease (CD) are unclear. We evaluated the morbidity and mortality of undiagnosed CD in a population-based sample of individuals 50 years of age and older.
  
  
  METHODS
  Stored sera from a population-based sample of 16,886 Olmsted County, Minnesota, residents 50 years of age and older were tested for CD based on analysis of tissue transglutaminase and endomysial antibodies. A nested case-control study compared serologically defined subjects with CD with age- and sex-matched, seronegative controls. Medical records were reviewed for comorbid conditions.
  
  
  RESULTS
  We identified 129 (0.8%) subjects with undiagnosed CD in a cohort of 16,847 older adults. A total of 127 undiagnosed cases (49% men; median age, 63.0 y) and 254 matched controls were included in a systematic evaluation for more than 100 potentially coexisting conditions. Subjects with undiagnosed CD had increased rates of osteoporosis and hypothyroidism, as well as lower body mass index and levels of cholesterol and ferritin. Overall survival was not associated with CD status. During a median follow-up period of 10.3 years after serum samples were collected, 20 cases but no controls were diagnosed with CD (15.2% Kaplan-Meier estimate at 10 years).
  
  
  CONCLUSIONS
  With the exception of reduced bone health, older adults with undiagnosed CD had limited comorbidity and no increase in mortality compared with controls. Some subjects were diagnosed with CD within a decade of serum collection, indicating that although most cases of undiagnosed CD are clinically silent, some result in symptoms. Undiagnosed CD can confer benefits and liabilities to older individuals.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Godfrey
authors.forename: Tricia L
authors.initials: TL
authors.lastname: Brantner
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Christensen
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Brogan
authors.forename: Carol T
authors.initials: CT
authors.lastname: Van Dyke
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Larson
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015519:Bone Density; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D005260:Female; D005293:Ferritins / Q000097:blood; D019204:GTP-Binding Proteins; D006306:Health Surveys; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D010024:Osteoporosis / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D013997:Time Factors; D011503:Transglutaminases / Q000276:immunology
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D005293:Ferritins; D002784:Cholesterol; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins