title: Trends and racial/ethnic disparities in gluten-sensitive problems in the United States: findings from the National Health and Nutrition Examination Surveys from 1988 to 2012.
abstract: OBJECTIVE
  Racial disparities in the prevalence of celiac disease (CD) and the number of people without CD avoiding gluten (PWAG) in the United States are unknown. We aimed to describe racial differences in the prevalence of CD and PWAG, and evaluate the trends of CD in the noninstitutionalized civilian adult population of the US between 1988 and 2012.
  
  
  METHODS
  A population-based cross-sectional study was conducted using data from the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 1994, 1999 to 2004, and 2009 to 2012. Serum samples from the NHANES participants were tested for CD serology, which included IgA tissue transglutaminase (tTG IgA) and, if findings were abnormal, for IgA endomysial antibodies. Information about adherence to a gluten-free diet was obtained by means of an interviewer-administered questionnaire.
  
  
  RESULTS
  In NHANES 2009-2012, the adjusted prevalence of CD was significantly higher (P<0.0001) among non-Hispanic whites (1.0%) than among non-Hispanic blacks (0.2%) and Hispanics (0.3%), whereas the adjusted prevalence of PWAG was significantly higher (P=0.01) in blacks (1.2%) as compared with Hispanics (0.5%) and whites (0.7%). The seroprevalence of CD in adults aged 50 years and older increased from 0.17% (95% confidence interval (CI) 0.03-0.33) in 1988-1994 to 0.44% (95% CI 0.24-0.81) in 2009-2012 (P<0.05).
  
  
  CONCLUSIONS
  The overall prevalence of CD increased between 1988 and 2012 and is significantly more common in whites. In addition, a higher proportion of individuals maintaining a gluten-free diet in the absence of a diagnosis of CD are blacks.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Rok Seon
authors: RS
authors: Choung
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Ivo C
authors: IC
authors: Ditah
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Ashley M
authors: AM
authors: Nadeau
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Alberto
authors: A
authors: Rubio-Tapia
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Eric V
authors: EV
authors: Marietta
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Tricia L
authors: TL
authors: Brantner
authors: Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Michael J
authors: MJ
authors: Camilleri
authors: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: S Vincent
authors: SV
authors: Rajkumar
authors: Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors: Ola
authors: O
authors: Landgren
authors: Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors: James E
authors: JE
authors: Everhart
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Joseph A
authors: JA
authors: Murray
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D002446:Celiac Disease / Q000178:diet therapy / Q000208:ethnology / Q000276:immunology; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free / Q000208:ethnology / Q000639:trends; D005006:Ethnicity; D005247:Feeding Behavior / Q000208:ethnology*; D005260:Female; D019204:GTP-Binding Proteins / Q000097:blood; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012698:Serologic Tests / Q000379:methods; D011503:Transglutaminases / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D000888:Antibodies, Anti-Idiotypic; C049937:anti-IgA; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins