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Subtle Laboratory and Clinical Precursors of Celiac Disease in Young Adults: A Large-Scale Retrospective Cohort Study
Ramon Cohen1,2,3,4, Shay Nemet5,6,7, Alena Kirzhner5,6,8
1Department of Internal Medicine B, Kaplan Medical Center, Rehovot, Israel. ramonco@clalit.org.il.
Insights
Subtle indicators like low hemoglobin, elevated liver enzymes, and lower BMI can precede celiac disease (CD) diagnosis in young adults by up to seven years. Early recognition aids timely screening and prevents complications.
Area of Science:
- Gastroenterology
- Immunology
- Internal Medicine
Background:
- Celiac disease (CD) is often underdiagnosed in adults due to non-specific symptoms.
- Delayed diagnosis of CD can lead to severe long-term health issues.
- Identifying early indicators in young adults is crucial for timely intervention.
Purpose of the Study:
- To identify subtle clinical and laboratory markers that precede celiac disease diagnosis in young adults aged 18-40.
- To analyze trends in laboratory values up to seven years before CD diagnosis.
- To assess the association between pre-diagnostic factors and the risk of CD diagnosis.
Main Methods:
- Retrospective cohort study of over 430,000 individuals.
- Identification of CD cases using ICD-9 codes and serological tests.
- Analysis of laboratory values and Body Mass Index (BMI) trends preceding diagnosis.
- Cox proportional hazards regression to determine risk associations.
Main Results:
- Lower hemoglobin and MCV in both males and females were associated with increased CD risk.
- Elevated liver enzymes (ALT) and lower BMI within normal ranges predicted later CD diagnosis.
- These subtle indicators were detectable up to seven years prior to formal diagnosis.
- Chronic gastrointestinal symptoms and genetic factors also preceded CD diagnosis.
Conclusions:
- Early identification of subtle indicators like low-normal hemoglobin, elevated liver enzymes, and lower BMI can facilitate earlier celiac disease screening.
- Recognizing these markers alongside GI symptoms and genetic predisposition is key for timely diagnosis in young adults.
- Prompt diagnosis of CD can mitigate potential long-term health consequences.
Background/Aim:
Celiac disease (CD) is frequently underdiagnosed in adults due to the absence of classic gastrointestinal symptoms, leading to delayed diagnosis and potential long-term complications. This study aimed to identify subtle clinical and laboratory indicators preceding CD diagnosis in young adults (18-40 years).
Methodology:
A retrospective cohort study was conducted using data from over 430,000 members of Clalit Health Services. Incident CD cases were identified by an ICD-9 code and a positive serological test. Laboratory values were analyzed for trends up to 7 years prior to diagnosis, and "relative" abnormalities were defined based on medians of diagnosed CD patients. Cox proportional hazards regression was used to assess the association between various pre-diagnostic clinical, laboratory, factors and the risk of CD diagnosis for 10 years.
Results:
Relative lower hemoglobin and MCV in males and females were associated with CD with HR of 2.15 (1.43-3.22) and 5,519 (4.41-7.41) respectively. Liver enzymes (ALT more than 22 U/L in females and 27 U/L in males), and lower BMI even within the normal range, were significantly associated with an increased risk of later CD diagnosis with HR of 1.881 (1.29-2.75) for women and 2.919 (1.81-4.71) for males. These subtle laboratory and BMI findings were observable as early as 7 years before formal diagnosis. Additionally, chronic gastrointestinal symptoms and chromosomal risk factors significantly preceded CD diagnosis.
Conclusion:
Early recognition of subtle indicators like low normal hemoglobin, elevated liver enzymes, and lower BMI, alongside persistent GI symptoms and genetic predispositions, can enable timelier screening and diagnosis of CD in young adults, potentially mitigating long-term health consequences.
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