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1.
Sports Health ; 12(3): 246-255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271135

RESUMO

BACKGROUND: Celiac disease (CD) is a common gastrointestinal pathology; however, prevalence and comorbidities are unknown in collegiate athletics. HYPOTHESES: (1) Athletes will have similar odds of CD as general population estimates (approximately 1 in 141) based on self-report and signs and symptoms, (2) athletes scoring higher on the Celiac Symptom Index (CSI) will have lower self-reported quality of life (QoL), (3) athletes scoring higher on the CSI will have higher depression scores, and (4) athletes scoring higher on the CSI will have higher perceived stress scores. STUDY DESIGN: Epidemiological cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: The CSI, WHO Quality of Life-BREF, Beck Depression Inventory, and Perceived Stress Scale were used to assess patients' signs and symptoms of CD and psychosocial measures/QoL in male and female National Collegiate Athletic Association (all divisions) athletes (N = 141). Participants also self-reported a formal diagnosis of CD. Chi-square analyses determined CD prevalence. Odds ratios determined risk for either being diagnosed with CD or reporting more symptoms than the general population. Correlational analyses determined whether symptoms correlated with QoL and psychosocial measures. RESULTS: Athletes were 3.85 times (95% CI, 0.42-34.89) more likely to report a CD diagnosis and were 18.36 times (95% CI, 2.40-140.48) more likely to report a high degree of CD symptoms than the general population. Athletes with more symptoms had worse physical, psychological, social, and environmental QoL indicators and higher depression and perceived stress scores. CONCLUSION: Athletes may be a higher risk population for experiencing CD and report greater signs/symptoms compared with general population estimates. Additionally, athletes with higher CD symptom scores also reported poorer QoL. CLINICAL RELEVANCE: Allied health care professionals should be aware of the diversity of CD symptoms and be prepared to refer athletes when gastrointestinal symptoms persist to ensure proper care and unhampered performance.


Assuntos
Doença Celíaca/epidemiologia , Qualidade de Vida , Esportes , Adolescente , Adulto , Causalidade , Doença Celíaca/diagnóstico , Doença Celíaca/etiologia , Doença Celíaca/psicologia , Estudos Transversais , Depressão , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Prevalência , Estresse Psicológico , Estados Unidos/epidemiologia , Adulto Jovem
2.
Rev Assoc Med Bras (1992) ; 66(1): 55-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130382

RESUMO

OBJECTIVE: It has been observed that celiac disease (CD) is not restricted to a single type characterized by diarrhea but also has atypical, asymptomatic (silent), and latent forms. The prevalence of this autoimmune disease, which affects approximately 1% of the world, is estimated to be around 3%, including atypical and asymptomatic cases. In our study, we aimed to evaluate adult celiac patients. METHODS: Between December 2008-2015, patients diagnosed with CD over the age of 18 years old were included in the study. Patients' symptoms at admission, frequency and type of anemia, transaminase levels, and celiac antibody positivity, and autoimmune diseases diagnosed at follow up were evaluated retrospectively. RESULTS: Of 195 patients, 151 (77.4%) were female. The mean age of the patients was 35.73 ± 12.19 years (range, 18-71 years). A hundred patients (51.3%) had gastrointestinal symptoms. At the time of admission, 118 patients (60.5%) had anemia, and 52 (26.7%) had hypertransaminasemia. During the mean follow-up period of 58 months (36-120 months), 84 (43.1%) of the patients presented at least one autoimmune disease, and this rate was 96.6% in individuals diagnosed above the age of 50 years. CONCLUSION: In adult CD, resistant anemia, dyspepsia, and hypertransaminasemia are very common findings at the time of diagnosis, and the association with other autoimmune diseases, especially Hashimoto's thyroiditis, is high.


Assuntos
Anemia/epidemiologia , Doenças Autoimunes/epidemiologia , Doença Celíaca/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Anemia/complicações , Doenças Autoimunes/complicações , Doença Celíaca/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estatísticas não Paramétricas , Centros de Atenção Terciária/estatística & dados numéricos , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/epidemiologia , Transaminases/sangue , Turquia/epidemiologia , Adulto Jovem
3.
Med J Aust ; 212(3): 126-131, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31909482

RESUMO

OBJECTIVES: To determine the incidence of self-reported non-coeliac wheat sensitivity (SR-NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance. DESIGN: Longitudinal cohort study; analysis of responses to self-administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018). SETTING, PARTICIPANTS: Subset of an adult population sample randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales. MAIN OUTCOME MEASURES: Prevalence of SR-NCWS (2015, 2018) and incidence and resolution of SR-NCWS, each by demographic and medical factors; prevalence of gluten avoidance and reasons for gluten avoidance (2018). RESULTS: 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR-NCWS was similar in 2015 (13.8%; 95% CI, 12.0-15.8%) and 2018 (13.9%; 95% CI, 12.1-15.9%); 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR-NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR-NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance); general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten. CONCLUSIONS: The prevalence of SR-NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR-NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR-NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance.


Assuntos
Doença Celíaca/epidemiologia , Autorrelato , Hipersensibilidade a Trigo/epidemiologia , Adulto , Idoso , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Dispepsia/epidemiologia , Feminino , Glutens/administração & dosagem , Humanos , Incidência , Síndrome do Intestino Irritável/epidemiologia , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Prevalência , Hipersensibilidade a Trigo/dietoterapia
4.
Ann Intern Med ; 172(1): ITC1-ITC16, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-31905394

RESUMO

Gluten-related disorders, including celiac disease, wheat allergy, and nonceliac gluten sensitivity (NCGS), are increasingly reported worldwide. Celiac disease is caused by an immune-mediated reaction to ingested gluten in genetically susceptible persons. NCGS is largely a diagnosis of exclusion when other causes of symptoms have been ruled out. All patients with celiac disease should be referred to a registered dietitian nutritionist with expertise in celiac disease and a gastroenterologist who specializes in celiac disease and malabsorptive disorders, and they should remain on a strict gluten-free diet indefinitely. This article provides an overview of gluten- and wheat-related disorders.


Assuntos
Doença Celíaca , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Doença Celíaca/epidemiologia , Diagnóstico Diferencial , Dieta Livre de Glúten , Suplementos Nutricionais , Endoscopia Gastrointestinal , Hospitalização , Humanos , Programas de Rastreamento , Educação de Pacientes como Assunto , Encaminhamento e Consulta
5.
PLoS One ; 15(1): e0226546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895924

RESUMO

BACKGROUND: Celiac disease (CD) is a systemic immune-mediated disorder developing in HLA genetically predisposed individuals carrying HLA-DQ2 and/or HLA-DQ8 molecules. Recent evidences supported a predominant importance of HLA-DQB1 locus and, in particular, HLA-DQB1*02 alleles. This diagnosis is poorly considered in Kazakhstan, because of the assumption that CD is not prevalent in this population. OBJECTIVE: To demonstrate that the genetic predisposition to CD in Kazakhstan is not negligible and is actually comparable to Western populations. METHODS: Through the analysis of HLA-DQ genotypes of healthy bone marrow donors from Kazakhstan's national registry, we estimated the HLA-related genetic predisposition to CD in the country. RESULTS: We demonstrated that the frequency of CD-related HLA-DQB1 alleles and, as a consequence, of predisposed individuals to CD in Kazakhstan is significant and comparable to countries with the highest disease prevalence. CONCLUSION: Considering the dietary style in Kazakhstan, including wheat as a staple food, these results provided a preliminary background of knowledge to expect a significant CD prevalence in Kazakhstan and Central Asia by implementing appropriate and cost-effective diagnostic strategies.


Assuntos
Doença Celíaca/epidemiologia , Predisposição Genética para Doença , Cadeias beta de HLA-DQ/genética , Polimorfismo Genético , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Alelos , Estudos de Casos e Controles , Doença Celíaca/genética , Feminino , Genótipo , Humanos , Cazaquistão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
6.
Gastroenterology ; 158(1): 151-159.e3, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560892

RESUMO

BACKGROUND & AIMS: Celiac disease can develop at any age, but outcomes of adults with positive results from serologic tests for tissue transglutaminase antibodies (tTGA) without endoscopic determination of celiac disease (called celiac autoimmunity) have not been thoroughly evaluated. We investigated the proportion of adults with celiac autoimmunity at a community medical center and their progression to celiac disease. METHODS: We analyzed waste blood samples from a community clinic from 15,551 adults for tTGA and, if titer results were above 2 U/mL, for endomysial antibody. The blood samples had been collected at 2 time points (median interval, 8.8 years) from 2006 through 2017. We collected data from the clinic on diagnoses of celiac disease based on duodenal biopsy analysis. RESULTS: Of the serum samples collected at the first time point, 15,398 had negative results for tTGA, and 153 had positive results for tTGA (>4 U/mL). Based on medical records, 6 individuals received a diagnosis of celiac disease, for a cumulative incidence of celiac disease diagnosis of 0.06% (95% confidence interval, 0.01-0.11). Forty-nine (0.32%) individuals with a negative result from the first serologic test for tTGA had a positive result from the second test. Among the 153 adults who were tTGA positive at the first time point, 31 (20%) had a subsequent diagnosis of celiac disease, 81 (53%) remained positive for tTGA without a clinical diagnosis of celiac disease, and 41 (27%) had negative test results for tTGA at the second time point. Higher initial tTGA titers, female sex, and a history of hypothyroidism and autoimmune disease were associated with increased risks of subsequent diagnosis of celiac disease. Interestingly, adults whose first blood sample had a positive test result but second blood sample had a negative result for tTGA were older, had lower-than-average initial tTGA titer results, and had a higher mean body mass index than adults whose blood samples were positive for tTGA at both time points and adults later diagnosed with celiac disease. CONCLUSIONS: In an analysis of serum samples collected from a community clinic an average of 8.8 years apart, we found that fewer than 1% of adults with negative results from an initial test for tTGA have a positive result on a second test. Of adults with positive results from the test for tTGA, only 20% are later diagnosed with celiac disease; the remaining individuals maintain persistent increases in tTGA without diagnoses of celiac disease or have negative results from second tests.


Assuntos
Autoanticorpos/sangue , Autoimunidade , Doença Celíaca/epidemiologia , Centros Comunitários de Saúde/estatística & dados numéricos , Proteínas de Ligação ao GTP/imunologia , Transglutaminases/imunologia , Adulto , Autoanticorpos/imunologia , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Prospectivos , Estudos Soroepidemiológicos
7.
Hautarzt ; 70(12): 960-963, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31584112

RESUMO

Coeliac disease and vitiligo are immune-mediated disorders that are often associated with other immune-mediated disorders. In a prospective study we included 174 patients with vitiligo between the ages of 3 and 79 years (mean 38.2 years) to investigate whether there is an increased risk for coeliac disease in patients with vitiligo. We determined immunoglobulin A and IgA- and IgG-antibodies against tissue transglutaminase, while also optionally measuring blood count, ferritin, and endomysial-IgA-antibodies. In 3 of 174 (1.7%) vitiligo patients, coeliac disease was diagnosed serologically and by duodenal biopsy. Assuming a coeliac disease prevalence of less than 0.0033%, the incidence is statistically significant. In two other patients with vitiligo, coeliac disease was already known and confirmed with biopsy. If these two patients are included in the calculation, 2.8% (5 von 176) of vitiligo patients have coeliac disease. This value is statistically significant even with a higher coeliac disease prevalence of 0.01. Thus, it is recommended that celiac-disease-specific antibodies also be determined during routine blood workup in vitiligo patients. In case of positive results, a gastroduodenoscopy with biopsy of the small intestine is recommended for diagnosis confirmation. If celiac disease is unlikely, a trial of gluten-free diet for a specific time should nevertheless be discussed with individuals affected by vitiligo because repigmentation appears possible.


Assuntos
Doença Celíaca , Vitiligo , Adolescente , Adulto , Idoso , Autoanticorpos , Doença Celíaca/complicações , Doença Celíaca/epidemiologia , Doença Celíaca/imunologia , Criança , Pré-Escolar , Humanos , Imunoglobulina A , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Vitiligo/complicações , Vitiligo/epidemiologia , Vitiligo/imunologia , Adulto Jovem
8.
Medicina (Kaunas) ; 55(9)2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31540157

RESUMO

BACKGROUND: A Spanish version of a questionnaire intended to estimate, at the population level, the prevalence rates of self-reported gluten-related disorders and adherence to gluten-free diets has been applied in four Latin American countries. However, idiom issues have hampered the questionnaire application in the Brazilian population. Thus, the aim of the present study was to carry out a translation, cultural adaptation, and evaluation of a Brazilian Portuguese questionnaire to estimate the self-reported prevalence of gluten-related disorders and adherence to gluten-free diets in a Brazilian population. MATERIALS AND METHODS: Two bilingual Portuguese-Spanish health professionals carried out the translation of the original Spanish version of the questionnaire to Brazilian-Portuguese. Matching between the two translations was evaluated using the WCopyFind.4.1.5 software. Words in conflict were conciliated, and the conciliated version of the Brazilian Portuguese instrument was evaluated to determine its clarity, comprehension, and consistency. A pilot study was carried out using an online platform. RESULTS: The two questionnaires translated into Brazilian Portuguese were highly matched (81.8%-84.1%). The questions of the conciliated questionnaire were clear and comprehensible with a high agreement among the evaluators (n = 64) (average Kendall's W score was 0.875). The participants did not suggest re-wording of questions. The answers to the questions were consistent after two applications of the questionnaire (Cohen's k = 0.869). The pilot online survey yielded low response rates (9.0%) highlighting the need for face-to-face interviews. CONCLUSIONS: The translation and evaluation of a Brazilian Portuguese questionnaire to estimate the self-reported prevalence rates of gluten-related disorders and adherence to gluten-free diets was carried out. The instrument is clear, comprehensible, and generates reproducible results in the target population. Further survey studies involving face-to-face interviews are warranted.


Assuntos
Doença Celíaca/epidemiologia , Dieta Livre de Glúten , Inquéritos e Questionários , Adulto , Brasil/epidemiologia , Doença Celíaca/dietoterapia , Características Culturais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Autorrelato , Traduções , Adulto Jovem
9.
Nutrients ; 11(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31382440

RESUMO

Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk.


Assuntos
Doença Celíaca/epidemiologia , Probióticos/administração & dosagem , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/genética , Doença Celíaca/genética , Doença Celíaca/imunologia , Criança , Pré-Escolar , Suplementos Nutricionais , Feminino , Predisposição Genética para Doença , Genótipo , Antígenos HLA/genética , Humanos , Lactente , Fórmulas Infantis , Recém-Nascido , Masculino , Fatores de Risco
10.
BMC Health Serv Res ; 19(1): 578, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419971

RESUMO

BACKGROUND: Celiac disease (CD) is an autoimmune chronic enteropathy of the small intestine caused by exposure to gluten in genetically predisposed individuals. CD is not easy to diagnose due to its unspecific symptomatology, especially in adults, a diagnosed/undiagnosed ratio of 1:7 is estimated. CD does not have its own code in the International Classification of Primary Care (ICPC) but it is coded under code D99 "Disease digestive system, other", which hinders diagnosis, intervention and research. The aim of this study is to investigate the prevalence of CD in Aragón, Spain, using the information available from Primary Care, as well as to discuss the difficulties involved in determining prevalence of CD from data collected at this level of medical intervention. METHODS: We designed an epidemiological cross-sectional study and analysed 26,964 electronic clinical records from the Aragonese Health Service under code ICPC D99 collected up to December 31st, 2016. The clinical records were classified by their editable field "descriptor" according to their probability of being related to CD. Analyses of gender, age, age at diagnosis, province and health sector were carried out. RESULTS: We found 4534 clinical records under 293 different descriptors with a high probability of referring to CD. Prevalence in Aragón was estimated to be 0.35% ranging from 0.24 to 0.81% with important differences among health sectors. CONCLUSIONS: The prevalence of 0.35% is a long way from the generally accepted 1% but within the usually considered ratio 1:7 of diagnosed:undiagnosed cases. Differences among sectors should be carefully analysed. Lacking its own ICPC code, diagnosis of CD in Primary Care Services is not included in a single category, but it is distributed under several descriptors, which makes it difficult to offer any firm diagnosis for treatment and hinders research. Finally, the high prevalence of CD justifies its own ICPC code and the need to withdraw CD from the generic D99 code "Disease digestive system other".


Assuntos
Doença Celíaca/epidemiologia , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Doença Celíaca/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia
11.
Mayo Clin Proc ; 94(9): 1807-1813, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31447136

RESUMO

OBJECTIVE: To investigate the prevalence of first-degree relatives (FDRs) with celiac disease detected at screening and diagnostic significance of anti-tissue transglutaminase (anti-TTG). PATIENTS AND METHODS: We performed a retrospective cohort study of 104 patients with a diagnosis of celiac disease and their FDRs, collecting data from electronic records of Mayo Clinic and celiac disease registry from December 20, 1983, to May 22, 2017. We collected demographics, presenting symptoms, indication for testing, family history, number of other family members screened, biopsy reports, and results of serologic tests. RESULTS: Of 477 FDRs identified, 360 were screened (mean screening rate per family, 79%±25%) and 160 FDRs (44.4%) were diagnosed with celiac disease, at a mean age 31.9±21.6 years (62% female). All diagnosed FDRs had positive anti-TTG titers. Clinical features were documented in 148 diagnosed FDRs, of those 9 (6%) had classic, 97 (66%) had non-classic symptoms, and 42(28%) had no reported symptoms. Histology reports were available from 155 FDRs: 12 (8%) had Marsh 1, 77 (50%) had Marsh 3a, and 66 (43%) had Marsh 3b. A level of anti-TTG greater than or equal to 2.75 of the upper limit of normal identified FDRs with villous atrophy with 87% sensitivity, 82% specificity, and a positive predictive value of 95%. CONCLUSION: In a retrospective cohort study of patients diagnosed with celiac disease, we found a high prevalence of celiac disease among screened FDRs. High anti-TTG titers associated with villous atrophy on small bowel biopsies, irrespective of symptoms.


Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Família , Proteínas de Ligação ao GTP/metabolismo , Sistema de Registros , Transglutaminases/metabolismo , Centros Médicos Acadêmicos , Adolescente , Adulto , Biópsia por Agulha , Doença Celíaca/imunologia , Criança , Estudos de Coortes , Feminino , Humanos , Imuno-Histoquímica , Masculino , Programas de Rastreamento , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Adulto Jovem
12.
Nutrients ; 11(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434238

RESUMO

We aimed to estimate the seroprevalence and the prevalence of coeliac disease (CD) in women with reproductive problems. A systematic review of English published articles until June 2019 was performed in PubMed and Scopus using the terms: (infertility and (coeliac disease OR gluten) OR (miscarriage and (coeliac disease OR gluten) OR (abortion and (coeliac disease OR gluten). All articles showing numerical data of anti-transglutaminase type 2 or anti-endomisium antibodies, or intestinal biopsy information were included. The study group comprised women with overall infertility, unexplained infertility, or recurrent spontaneous abortions. Two authors independently performed data extraction using a predefined data sheet. The initial search yielded 310 articles, and 23 were selected for data extraction. After meta-analysis, the pooled seroprevalence was very similar for overall and unexplained infertility, with a pooled proportion of around 1.3%-1.6%. This implies three times higher odds of having CD in infertility when compared to controls. The pooled prevalence could not be accurately calculated due to the small sample sizes. Further studies with increased sample sizes are necessary before giving specific recommendations for CD screening in women with reproductive problems, but current data seem to support a higher risk of CD in these women.


Assuntos
Doença Celíaca/epidemiologia , Infertilidade Feminina/epidemiologia , Aborto Habitual/epidemiologia , Autoanticorpos/sangue , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Duodeno/patologia , Grupos Étnicos , Feminino , Proteínas de Ligação ao GTP/imunologia , Humanos , Imunoglobulina A/sangue , Gravidez , Transglutaminases/imunologia
13.
JAMA ; 322(6): 514-523, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31408136

RESUMO

Importance: High gluten intake during childhood may confer risk of celiac disease. Objectives: To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children. Design, Setting, and Participants: The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017. Exposures: Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years. Main Outcomes and Measures: The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels. Results: Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]). Conclusions and Relevance: Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.


Assuntos
Autoanticorpos/sangue , Doença Celíaca/etiologia , Proteínas na Dieta/efeitos adversos , Predisposição Genética para Doença , Glutens/efeitos adversos , Transglutaminases/imunologia , Autoimunidade , Doença Celíaca/epidemiologia , Doença Celíaca/genética , Doença Celíaca/imunologia , Pré-Escolar , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/genética , Registros de Dieta , Feminino , Glutens/administração & dosagem , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Risco
15.
Saudi Med J ; 40(7): 647-656, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287124

RESUMO

OBJECTIVES: To characterize and meta-analyze the pertinent studies concerning celiac disease (CD) among patients with type 1 diabetes mellitus (T1DM) in the Kingdom of Saudi Arabia. Methods: Data (from the relevant articles) were analyzed using both the Statistical Package for Social Sciences, version 20 (IBM Corp., Armonk, NY, USA) program and the comprehensive meta-analysis (CMA) program. This study was conducted between March and July 2018 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Written ethical approval was not obtained because this study was a retrospective literature review and analysis. Results: The prevalence of seropositive-CD was 15.88% with high heterogeneity (I2=84.0), while the prevalence of biopsy-proven CD was 12% with high heterogeneity (I2=82.7). Anti-transglutaminase was used in 7 of the 8 studies; alone in 4; with endomysial antibodies in 2; and with antigliadin antibodies (AGA) in one. In the remaining study, antireticulin antibodies was used with AGA. The age of the involved patients ranged from 8 months to 50 years old. Conclusion: The prevalence of biopsy-proven CD among T1DM patients in Kingdom of Saudi Arabia (12.0%) was double the global prevalence (6.0%), and much higher than the normal Saudi population (1.4%). The female-to-male ratio (2:1) of CD patients in T1DM was the same as in the normal population in Kingdom of Saudi Arabia. No significant difference was detected between the reported serologically-proven rates and the reported biopsy-proven rates (p=0.093).


Assuntos
Doença Celíaca/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Anticorpos/imunologia , Biópsia , Doença Celíaca/imunologia , Doença Celíaca/patologia , Comorbidade , Humanos , Arábia Saudita/epidemiologia
16.
BMC Med ; 17(1): 142, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31331324

RESUMO

BACKGROUND: Celiac disease remains a challenging condition because of a steady increase in knowledge tackling its pathophysiology, diagnosis, management, and possible therapeutic options. MAIN BODY: A major milestone in the history of celiac disease was the identification of tissue transglutaminase as the autoantigen, thereby confirming the autoimmune nature of this disorder. A genetic background (HLA-DQ2/DQ8 positivity and non-HLA genes) is a mandatory determinant of the development of the disease, which occurs with the contribution of environmental factors (e.g., viral infections and dysbiosis of gut microbiota). Its prevalence in the general population is of approximately 1%, with female predominance. The disease can occur at any age, with a variety of symptoms/manifestations. This multifaceted clinical presentation leads to several phenotypes, i.e., gastrointestinal, extraintestinal, subclinical, potential, seronegative, non-responsive, and refractory. Although small intestinal biopsy remains the diagnostic 'gold standard', highly sensitive and specific serological tests, such as tissue transglutaminase, endomysial and deamidated gliadin peptide antibodies, have become gradually more important in the diagnostic work-up of celiac disease. Currently, the only treatment for celiac disease is a life-long, strict gluten-free diet leading to improvement in quality of life, ameliorating symptoms, and preventing the occurrence of refractory celiac disease, ulcerative jejunoileitis, and small intestinal adenocarcinoma and lymphoma. CONCLUSIONS: The present review is timely and provides a thorough appraisal of various aspects characterizing celiac disease. Remaining challenges include obtaining a better understanding of still-unclear phenotypes such as slow-responsive, potential (minimal lesions) and seronegative celiac disease. The identification of alternative or complementary treatments to the gluten-free diet brings hope for patients unavoidably burdened by diet restrictions.


Assuntos
Doença Celíaca , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Doença Celíaca/imunologia , Doença Celíaca/terapia , Diagnóstico Diferencial , Dieta Livre de Glúten , Humanos , Imunidade Inata/fisiologia , Fenótipo , Qualidade de Vida , Testes Sorológicos
17.
Nutrients ; 11(8)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349675

RESUMO

The prevalence and associated factors of daily life restrictions due to a gluten-free diet in adult celiac disease patients diagnosed in childhood are poorly known. We investigated these issues by collecting the medical data of 955 pediatric patients and sending questionnaires evaluating various health outcomes to the 559 patients who had reached adulthood. Of the 231 respondents, 46% reported everyday life restrictions caused by dietary treatment. Compared with those without restrictions, they more often had anemia at diagnosis (37% vs. 22%, p = 0.014), but the groups were comparable in other diagnostic features. In adulthood, patients with restrictions reported more overall symptoms (32% vs. 17%, p = 0.006), although the symptoms measured with the Gastrointestinal Symptom Rating Scale questionnaire were comparable. Despite strict dietary adherence in both groups, the experience of restrictions was associated with dietary challenges (34% vs. 9%, p < 0.001), health concerns (22% vs. 13%, p = 0.050), and lower vitality scores in the Psychological General Well-Being questionnaire. The groups did not differ in their current age, socioeconomic status, family history of celiac disease, general health or health-related lifestyle, the presence of co-morbidities, or regular follow up. Our results encourage healthcare professionals to discuss the possible health concerns and dietary challenges with patients to avoid unnecessary daily life restrictions, especially when young patients start to take responsibility for their treatment.


Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten/efeitos adversos , Atividades Cotidianas , Adolescente , Adulto , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Doença Celíaca/fisiopatologia , Criança , Feminino , Humanos , Masculino , Estado Nutricional , Valor Nutritivo , Cooperação do Paciente , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
18.
Orv Hetil ; 160(25): 980-986, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31203642

RESUMO

Introduction and aim: With the rising consumer's health awareness, especially towards patients with celiac disease, gluten has become a food ingredient to be avoided by many people expecting various positive health effects. The strict adherence of diet requires serious abandonments and lifestyle changes that affect directly their quality of life. The aim of the present study was to recognise the quality of life of Hungarian and Romanian consumers following a gluten-free diet as well as to explore the negative effects on them. Method: An online questionnaire survey was conducted upon 1155 Hungarian and Romanian respondents. Results: For gluten-free consumers, self-control was relatively easy to overcome, but their lifestyle was negatively affected by social events and dining out. In addition, diet adherence was a burden from both lifestyle and financial point of view. For Hungarian consumers, external factors such as price, choice, taste and availability of products had become a major obstacle, while Romanian ones were more likely to be affected by internal factors (product information, diet knowledge, lifestyle, self-control). Mandatory labelling of substances and products causing allergies and intolerances has achieved its purpose, as it has made it easier for consumers on diet to choose food and increased their confidence. Conclusions: The study points out that dieters' quality of life can be enhanced not only by general actions (improving the preparedness of out-of-home meal services and rationalising the price of products), but also through country-specific community intervention. Orv Hetil. 2019; 160(25): 980-986.


Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten/psicologia , Qualidade de Vida , Adulto , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hungria/epidemiologia , Masculino , Romênia/epidemiologia , Inquéritos e Questionários
19.
Arab J Gastroenterol ; 20(2): 95-98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31182344

RESUMO

BACKGROUND AND STUDY AIMS: Juvenile idiopathic arthritis (JIA) is characterized by autoimmune aetiology. A gene locus 4q27 related to rheumatoid arthritis, psoriatic arthritis, and coeliac disease is associated with susceptibility to JIA. There are reports indicating several patients with JIA had been diagnosed with CD. We aimed to assess the frequency of coeliac disease (CD) in patients with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: This prospective study was carried out from October 2015 to August 2016 and included 96 patients with JIA. All patients were evaluated in terms of clinical and laboratory findings of CD. Levels of total IgA and tissue transglutaminase antibody (tTG) IgA were measured in all patients. Those with increased level of tTG IgA were further tested for anti-endomysium IgA antibodies (EMA). Gastroduodenoscopy were planned for a definite diagnosis of CD in patients with positive EMA. RESULTS: Of the 96 patients in our study, 34 (35.4%) had oligoarticular form of JIA, 29 (30.2%) had polyarticular form, 12 (12.5%) had ERA form, 11 (11.5%) had systemic form, and 10 (10.4%) had psoriatic form. Sixteen of our patients (16.6%) were not using any drugs during the study. Neither EMA IgA antibodies were analysed nor gastro-duodenoscopy was performed because no patients were positive for tTG IgA. There was no difference in terms of tTG levels between the patients using NSAIDs or other drugs. CONCLUSION: We did not find CD in children with JIA. Long term studies with more JIA patients are needed to provide more precise interpretation.


Assuntos
Artrite Juvenil/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Adolescente , Artrite Juvenil/sangue , Artrite Juvenil/tratamento farmacológico , Doença Celíaca/sangue , Criança , Comorbidade , Feminino , Proteínas de Ligação ao GTP/imunologia , Humanos , Imunoglobulina A/sangue , Incidência , Masculino , Estudos Prospectivos , Transglutaminases/imunologia , Turquia/epidemiologia
20.
Int J Immunogenet ; 46(5): 342-345, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31187602

RESUMO

Through a retrospective analysis of a real-life cohort of children with celiac disease (CD), who underwent HLA-DQ genotyping, we supported our previous findings indicating the presence of HLA-DQB1*02 allele in at least 90%-95% of pediatric patients. In the present study, reporting the HLA-DQ analysis from 184 children (age range: 1-16 years) diagnosed with CD in a single centre, we found that 97.29% of all these CD children (n = 179 out of 184 genotyped patients) resulted to be carriers of at least one copy of HLA-DQB1*02 allele. If a widened screening for CD should result to be appropriate in the pediatric population after further clinical research, this observation might be potentially exploited to consider a two-step screening strategy, starting with the HLA-DQB1*02 targeted analysis followed by the specific serology for CD in these predisposed patients only. However, additional and larger studies are needed to support our findings.


Assuntos
Alelos , Doença Celíaca/genética , Predisposição Genética para Doença , Variação Genética , Cadeias beta de HLA-DQ/genética , Adolescente , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Criança , Pré-Escolar , Feminino , Testes Genéticos , Genótipo , Humanos , Lactente , Masculino , Programas de Rastreamento , Estudos Retrospectivos
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