Study finds micronutrient deficiencies common at time of celiac disease diagnosis

ROCHESTER, Minn. — Micronutrient deficiencies, including vitamins B12 and D, as well as folate, iron, zinc and copper, are common in adults at the time of diagnosis with celiac disease. These deficiencies should be addressed at that time, according to a study by Mayo Clinic researchers.

The retrospective study of 309 adults newly diagnosed with celiac disease at Mayo Clinic from 2000 to 2014 also found that low body weight and weight loss, which are commonly associated with celiac disease, were less common. Weight loss was seen in only 25.2% of patients, and the average body mass index was categorized as overweight. The study will appear in the July issue of Mayo Clinic Proceedings.

“It was somewhat surprising to see the frequency of micronutrient deficiencies in this group of newly diagnosed patients, given that they were presenting fewer symptoms of malabsorption,” says Adam Bledsoe, M.D., a gastroenterology fellow at Mayo Clinic’s Rochester campus.

Celiac disease is an immune reaction to consuming gluten, a protein found in wheat, barley and rye. Eating gluten triggers an immune response in the small intestine that over time damages the intestine’s lining and prevents it from absorbing some nutrients, leading to diarrhea, fatigue, anemia, weight loss and other complications.

Based on recent data, the prevalence of celiac disease in the U.S. is 1 in 141 people, and its prevalence has increased over the past 50 years.

“Our study suggests that the presentation of celiac disease has changed from the classic weight loss, anemia and diarrhea, with increasing numbers of patients diagnosed with nonclassical symptoms,” says Dr. Bledsoe, the study’s primary author. “Micronutrient deficiencies remain common in adults, however, and should be assessed.” Assessment should include vitamin D, iron, folic acid, vitamin B12, zinc and copper.

Zinc deficiency was observed most frequently at diagnosis, the study says, with 59.4% of patients having a deficiency. Other deficiencies included iron, vitamin D, copper, vitamin B12 and folate.

The nutritional deficiencies have potential health ramifications, though in this retrospective study the clinical implications remain unknown. “Further studies are needed to better define the implications of the deficiencies, optimal replacement strategies and follow-up,” says Dr. Bledsoe.

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Joseph Murray, M.D., a Mayo Clinic gastroenterologist and the study’s senior author, receives grant support from Mayo Clinic, ImmusanT Inc., the National Institutes of Health, ImmunogenX LLC, Takeda Pharmaceutical Company Limited, Allakos Inc., Oberkotter Foundation, and Cour Pharmaceuticals Inc. He is a consultant to Bionix Medical Technologies, Lilly Research Laboratories, Johnson & Johnson, Dr. Schar USA Inc., UCB Biopharma, Innovate Biopharmaceuticals, Glenmark Pharmaceuticals, Celimmune LLC, Intrexon Corp., and Boehringer Ingelheim International GmbH. Dr. Murray holds patent license to Evelo Biosciences Inc. and receives royalties from Torax Medical Inc. Another author, Melissa Snyder, Ph.D., of Mayo Clinic’s Division of Clinical Biochemistry, has served on the strategic advisory committee for Inova Diagnostics Inc. No other authors have conflicts to disclose.

Mayo Clinic Proceedings is a monthly peer-reviewed medical journal that publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. Proceedings is sponsored by the Mayo Foundation for Medical Education and Research as part of its commitment to physician education. It publishes submissions from authors worldwide. The journal has been published for more than 80 years and has a circulation of 130,000. Visit the Mayo Clinic Proceedings website to view articles.

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