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Celiac disease, iron deficiency linked only in Caucasians
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Caucasians with iron deficiency are at increased risk for developing celiac disease, while iron-deficient non-Caucasians are not, according to recent results.
Researchers evaluated serum samples from 1,713 patients, including 1,100 Caucasians and 613 non-Caucasians (221 African-Americans, 153 Asians and 239 Hispanic participants). Prevalence of celiac disease (CD) was compared between patients with iron deficiency (ferritin levels of 12 mcg/L or lower) and matched, nondeficient controls. HLA genotype also was assessed in a subset of 706 Caucasian participants.
All participants had been enrolled in the screening phase of the Hemochromatosis and Iron Overload Screening study, which included participants from five US and Canadian field centers. Men were aged 25 years or older; women were aged 50 years or older.
Of 567 evaluable iron-deficient patients, 14 had CD vs. one of 1,142 evaluable controls. All participants with CD were Caucasian (4% of Caucasians vs. 0 non-Caucasians; P=.003).
Iron-deficient patients were significantly more likely than controls to develop celiac disease (OR=28; 95% CI, 3.7-212.8). The presence of any HFE genotype did not alter this risk increase (OR=28; 95% CI, 3.7-214.3), and HFE genotype frequency was similar across iron-deficient and nondeficient participants, and between Caucasians and non-Caucasians.
The 706-participant subset included 357 iron-deficient patients and 349 controls. Among them, 139 had the DQ8 variant, 177 the DQ2.2 or DQ4 variant and 161 the DQ2.5 variant. CD was observed in 13 of those with the DQ2.5 variant and five with DQ2.2 or DQ4 variant. Investigators observed an association only between CD and DQ2.5 among iron-deficient participants compared with controls (P=7.183 x 10-8).
“Analyses … identified an increased rate of CD in those within the iron-deficient cases and just one case of the iron-replete controls,” the researchers wrote. “CD was confined to those Caucasians with iron deficiency and did not appear to affect other races, even those with iron deficiency.
“This suggests that CD is primarily a disease affecting Caucasians and, if replicated in larger datasets, it would indicate that CD is not a significant clinical concern in non-Caucasian individuals.”
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