Study confirms malabsorption is a sign of celiac disease

A large observational cohort study conducted in Copenhagen confirmed that malabsorption is associated with celiac disease, according to researchers.

The findings were published in Scientific Reports.

“This study identified several biochemical abnormalities associated with celiac disease (CD) antibody positivity in a primary care setting among individuals referred to CD antibody testing,” Line Lund Kårhus, MD, PhD, the head of epidemiology at Frederiksberg Hospital in Denmark, and colleagues wrote. “The pattern of abnormalities suggested that micronutrient deficiencies were prevalent among CD antibody-positive individuals.”

Kårhus and colleagues used data from the Copenhagen General Practitioners’ Laboratory (CGPL); the Danish National Patient Register from 1978 to 2019; and the Danish Civil Registration System until 2018. In total, 57,061 individuals (median age, 30 years) were included in the study.

Among the study cohort, 706 individuals received a positive CD antibody result; 72.7% were women and the mean age was 26 years. The researchers compared the results of those with CD-positive antibodies with individuals with CD-negative antibodies. The “most remarkable” difference between the groups was the markedly lower ferritin among CD antibody-positive individuals compared with CD antibody-negative individuals (women: 13.8 µg/L vs. 35.9 µg/L; men: 34.3 µg/L vs. 80.4 µg/L), Kårhus and colleagues reported. Also, CD antibody-positive individuals had a tendency for lower hemoglobin (women: 7.8 mmol/L vs. 8.1 mmol/L; men: 8.5 mmol/L vs. 8.8 mmol/L). The researchers reported lower cobalamin and folic acid levels and higher levels of transferrin, alanine transaminase and alkaline phosphate among CD antibody-positive individuals.

Compared with CD-negative individuals, the researchers reported that a greater proportion of tests among CD antibody-positive individuals exhibited hemoglobin (10.2% vs. 2.7%), mean corpuscular volume (7.1% vs. 2.9%), mean corpuscular hemoglobin concentration (6.8% vs. 1.2%) and ferritin (37.6% vs. 7.6%) below the reference level, while transferrin (20.7% vs. 9.5%) was above the reference interval. CD antibody-positive individuals were also more likely to have a deficiency for cobalamin and folic acid.

“These findings illustrate the possibility of prospective development of biochemical algorithms to improve guidelines for CD screening to reduce diagnostic delay and underdiagnosis of CD and to lead to early treatment and prevention of comorbidities in patients with CD,” Kårhus and colleagues wrote.