title: Prevalence of Adult Celiac Disease in India: Regional Variations and Associations.
abstract: OBJECTIVE
  Although celiac disease (CeD) affects 1% of people in the northern part of India, it is believed to be uncommon in the southern and northeastern parts because of significant differences in dietary pattern and ethnicity. We estimated the prevalence of CeD in these three populations. In a subset, we also investigated differences in the prevalence of HLA-DQ 2/8 allelotype and dietary grain consumption.
  
  
  METHODS
  A total of 23,331 healthy adults were sampled from three regions of India-northern (n=6207), northeastern (n=8149), and southern (n=8973)-and screened for CeD using IgA anti-tissue transglutaminase antibody. Positive tests were reconfirmed using a second ELISA. CeD was diagnosed if the second test was positive and these participants were further investigated. A subsample of participants was tested for HLA-DQ2/-DQ8 and underwent detailed dietary evaluation.
  
  
  RESULTS
  Age-adjusted prevalence of celiac autoantibodies was 1.23% in northern, 0.87% in northeastern, and 0.10% in southern India (P<0.0001). Prevalence of CeD and latent CeD, respectively, was 8.53/1,000 and 3.70/1,000 in northern, 4.66/1,000 and 3.92/1,000 in northeastern, and 0.11/1,000 and 1.22/1,000 in the southern part. The population prevalence of genes determining HLA-DQ2 and/or -DQ8 expression was 38.1% in northern, 31.4% in northeastern, and 36.4% in southern India. Mean daily wheat intake was highest in northern (455 g) compared with northeastern (37 g) or southern part (25 g), whereas daily rice intake showed an inverse pattern.
  
  
  CONCLUSIONS
  CeD and latent CeD were most prevalent in northern India and were the least in southern India. The prevalence correlated with wheat intake and did not reflect differences in the genetic background.
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: B S
authors.initials: BS
authors.lastname: Ramakrishna
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Govind K
authors.initials: GK
authors.lastname: Makharia
authors.affiliation: Department of Gastroenterology, International Hospital, Guwahati, India.
authors.forename: Kamal
authors.initials: K
authors.lastname: Chetri
authors.affiliation: Department of Medicine, Guwahati Medical College, Guwahati, India.
authors.forename: Sangitanjan
authors.initials: S
authors.lastname: Dutta
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vineet
authors.initials: V
authors.lastname: Ahuja
authors.affiliation: Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ritvik
authors.initials: R
authors.lastname: Amarchand
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Ramadass
authors.initials: R
authors.lastname: Balamurugan
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Sudipta D
authors.initials: SD
authors.lastname: Chowdhury
authors.affiliation: Department of Transfusion Medicine, Christian Medical College, Vellore, India.
authors.forename: Dolly
authors.initials: D
authors.lastname: Daniel
authors.affiliation: Department of Medicine, Guwahati Medical College, Guwahati, India.
authors.forename: Anup
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Gemlyn
authors.initials: G
authors.lastname: George
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Siddhartha Datta
authors.initials: SD
authors.lastname: Gupta
authors.affiliation: Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Department of Community Health, Christian Medical College, Vellore, India.
authors.forename: Jasmin H
authors.initials: JH
authors.lastname: Prasad
authors.affiliation: Department of Transfusion Medicine and Immunohematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Gurvinder
authors.initials: G
authors.lastname: Kaur
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Pugazhendhi
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Anna
authors.initials: A
authors.lastname: Pulimood
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Ramakrishna
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Verma
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000453:epidemiology*; D004032:Diet; D002523:Edible Grain; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult