title: Predictors of dietary gluten avoidance in adults without a prior diagnosis of celiac disease.
abstract: OBJECTIVE
  Prior studies have shown that dietary gluten avoidance (DGA) is relatively common in children without previously diagnosed celiac disease (CD), and several clinical predictors of DGA have been found. However, available data on predictors of DGA in adults without diagnosed CD are limited. The aim of this study was to determine the independent predictors of DGA in this population.
  
  
  METHODS
  We performed a structured medical record review of 376 patients, ages ≥ 20 y, who had never been formally diagnosed with CD, presenting for an initial CD evaluation (ICD-9-CM 579.0) between January 2000 and December 2010 at two large Boston teaching hospitals. We collected data including demographic characteristics, medical history, history of CD serology before referral, and self-reported DGA. Predictors of DGA were determined using multivariable logistic regression.
  
  
  RESULTS
  Mean age was 47 (SD = 17) years. We found that 41 patients (10.9%; 95% confidence interval [CI], 7.9-14.5) had avoided gluten at some time in their lives. Most patients had subjective abdominal complaints or bowel movement changes. History of CD seropositivity before referral was noted in 14%. Independent predictors of DGA (P < 0.05) were lactose intolerance (odds ratio [OR], 2.8; 95% CI, 1.1-7.5), food allergy (OR, 3.8; 95% CI, 1.04-13.7), and history of positive serology of less-specific CD markers before the referral (OR, 3.2; 95% CI, 1.3-7.9).
  
  
  CONCLUSIONS
  Gluten avoidance is common in a clinic population of adults without prior CD diagnosis. The recognized predictors suggest that DGA may associate with conditions presenting with nonspecific gastrointestinal complaints and perhaps with the perceived benefits of DGA among patients with prior history of positive CD serology.
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: Tuinoi1@gmail.com.
authors.forename: Pornthep
authors.initials: P
authors.lastname: Tanpowpong
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Sarabeth
authors.initials: S
authors.lastname: Broder-Fingert
authors.affiliation: Harvard Medical School, Boston, MA, USA; Division of Pediatric Gastroenterology, Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Aubrey J
authors.initials: AJ
authors.lastname: Katz
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology*; D055050:Diet, Gluten-Free; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology; D005983:Glutens / Q000008:administration & dosage; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005983:Glutens
keywords: Allergy; Diarrhea; Lactose; Predictors; Serology