Celiac Disease: Data from the National Health and Nutrition Examination Survey 2009 - 2014

Abstract

Background: Celiac disease is a gastrointestinal malabsorptive disorder characterized by intestinal villous atrophy and triggered by an autoimmune response to gluten, leading to malnutrition and secondary conditions including osteoporosis. There is still a scarcity of information on the nutritional intake of adults with celiac disease as it relates to their bone health. Objective: To evaluate differences in nutritional intake of calcium, vitamin D, and phosphorus; serologic concentrations of these nutrients; and bone health among adults with and without celiac disease. Design: Cross-sectional data was retrieved from the National Health and Nutrition Examination Survey (NHANES) cycles 2009-10, 2011-12, and 2013-14. Data including self-reported dietary and supplement intake from 24-hour recalls, serologic nutrient status, and dual x-ray absorptiometry (DXA) scans were collected from 50 serologically positive (EMA+) adults with celiac disease. The serologically positive (EMA+) participants were an average age of 42 years old (range 18-80 years). Results were compared with those of 15,176 control subjects using multiple linear regression modelling controlled for age, sex, and race/ethnicity. Results: Adults with celiac disease consumed significantly more total calcium (Ca) (1608 vs. 1152 mg Ca/day, p = 0.031) than the control group. They had significantly higher serum phosphorus concentrations (4.0 vs. 3.8 mg/dL, p = 0.002) than the controls. In the multiple-adjusted model, positive serologic (EMA+) status predicted a 344.2 kcal (95% CI: 6.6, 681.8) increase in daily caloric intake, -0.1 g/cm2 (95% CI: -0.2, 0.0) decrease in femur BMD, -0.4 g (95% CI: -0.6, -0.1) decrease in femoral neck BMC, and - 0.1 g/cm2 (95% CI: -0.1, 0.0) decrease in femoral neck BMD. Conclusion: Despite greater overall calcium intake, adults who tested positive for celiac disease (EMA+) had lower serum calcium concentrations and lower overall bone mass than adults without celiac disease.