Prevalence and Predictors of Folate Deficiency in Patients with Celiac Disease

Celiac disease (CeD) causes small bowel villus atrophy and may contribute to folate deficiency through both malabsorption and folate-deficient gluten-free diets (GFD). We sought to determine the prevalence and predictors of folate deficiency among adults with CeD treated at a single tertiary referral center.

In this cross-sectional study, folate-deficient and non-deficient CeD patients were compared by age, sex, presentation type, villus atrophy severity at diagnosis and follow-up, prior malignancy, and concomitant autoimmune disease. All patients received routine counseling to follow a GFD, although adherence was not quantified.

Among 825 patients (73% female), 58 (7%) had folate deficiency. Mean age at folate measurement was 43 (SD=18) years. Mean interval from time of diagnosis to folate measurement in folate-deficient and non-deficient patients was 8 vs 9 years, respectively (p=0.357). Folate-deficient patients were younger at folate measurement and CeD diagnosis (37 vs 44 years and 28 vs 34 years; p=0.002 and p=0.018). Ulcerative colitis was more common (5.2% vs 0.3%, p=0.003), while hypothyroidism was less common (6.9% vs 19%, p=0.022) among folate-deficient patients.

Folate deficiency is common in treated CeD and was associated with younger age and concomitant ulcerative colitis. Persistent deficiency may be related to folate-deficient GFDs or persistent gluten-driven inflammation. Differences in mean age between folate-deficient and non-deficient groups may be related to differing supplement use behaviors. Further studies are needed to guide screening and supplementation strategies and determine utility of grain fortification.