Dr. Ron’s Research Review – February 18, 2015

© 2014                                                                                                        

This week’s research review focuses on celiac disease, iron deficiency and HDL.

A study found that in iron deficiency, those with HDL levels ≤30mg/dl were eight times as likely to have celiac disease.

A cross-sectional study compared CD patients who presented with IDA with patients who presented with IDA due to non-CD. Each CD patient was matched by age and gender with up to three IDA controls selected from a separate IDA database. IDA was defined as a hemoglobin level < 12 g/dl for women and <13 for men with serum ferritin <30ng/ml.
Of the CD patients, 48% had an HDL level ≤40 mg/dl compared with 24% of controls (P = 0.001), and 16% of CD patients had HDL levels ≤25 mg/dl, whereas none of the controls had such a level (P < 0.0001). After adjusting for BMI and the use of lipid-lowering medications, individuals with HDL levels ≤40 mg/dl were more than five times as likely to have CD as those with levels > 40 mg/dl. Those with HDL levels ≤30mg/dl were eight times as likely to have CD, and the cutoff point was highly predictive of having CD with a positive predictive value of 61% and a positive likelihood ratio of 6. (Abu Daya et al., 2014)

Dr. Ron


 

Articles

Utilizing HDL levels to improve detection of celiac disease in patients with iron deficiency anemia.
            (Abu Daya et al., 2014) Download
BACKGROUND & AIMS: Anemia is considered to be an atypical or silent presentation of celiac disease, compared with the classic presentation with diarrhea. However, little information is available about how these groups compare in terms of disease severity. We compared the severity of celiac disease between patients who present with anemia vs those who present with diarrhea. METHODS: The study cohort was selected from a database of patients with celiac disease who were evaluated at a tertiary referral center between 1990 and 2011. Severity of celiac disease was assessed by the degree of villous atrophy and clinical and serologic parameters. Patients were compared according to mode of presentation and sex. Multivariable analyses, adjusting for age and sex, were conducted to assess the association between the mode of celiac disease presentation and cholesterol level, bone density, severity of villous atrophy, erythrocyte sedimentation rate, and level of anti-tissue transglutaminase. RESULTS: Of 727 patients, 77% presented with diarrhea and 23% with anemia (92% iron deficient). On multiple regression analysis, presentation with anemia was associated with lower levels of total cholesterol (P = .02) and high-density lipoprotein (P = .002) and a higher erythrocyte sedimentation rate (P = .001) and level of anti-tissue transglutaminase (P = .01). Presentation with anemia was associated with lower level of cholesterol only in women. Anemic patients were more than 2-fold more likely to have severe villous atrophy and a low bone mass density at the time they were diagnosed with celiac disease than patients who presented with diarrhea. CONCLUSIONS: Celiac disease patients who present with anemia have more severe disease than those who present with diarrhea. There also appear to be sex-specific differences with regard to the association between anemia and the different features of celiac disease.

References

Abu Daya, H., et al. (2014), ‘Utilizing HDL levels to improve detection of celiac disease in patients with iron deficiency anemia.’, Am J Gastroenterol, 109(5) (5), 769-70. PubMedID: 24797006