In the Journals

Reasons for avoiding gluten vary regionally, nationally

Benjamin Lebwohl, MD, MS
Benjamin Lebwohl

Relative proportions of celiac disease and non-celiac gluten sensitivity among individuals who avoid dietary gluten vary significantly across the U.S. and the world, according to new research.

More than a quarter of survey respondents (28.6%) avoided gluten due to self-reported non-celiac gluten sensitivity, researchers noted.

“Despite the marked rise in practice of avoiding gluten in recent years, our understanding of the epidemiology of this phenomenon (the where and the why) remains limited,” Benjamin Lebwohl, MD, MS, director of clinical research at The Celiac Disease Center at Columbia University, told Healio Gastroenterology.

To better understand reasons for gluten avoidance, Lebwohl and colleagues evaluated responses to a questionnaire on the website for the Nima sensor (Nima Labs), a portable device for detecting gluten in food. They assessed data provided by individuals with either celiac disease (n = 6,474) or non-celiac gluten sensitivity (n = 2,597) from 15 global regions and four U.S. regions.

“We found that among people interested in a gluten-detection device, the relative frequency of non-celiac patients was greatest in the U.S., and within the U.S. it was highest in Western states,” Lebwohl said.

Most respondents in the U.S. did report having celiac disease (69.8%). The Northeast showed the highest ratio of celiac disease vs. non-celiac gluten sensitivity (74.3% vs. 25.7%), while the West showed the lowest (67.1% vs. 32.9%; P < .0001). These regional differences “are likely related to an interplay of genetic and environmental factors,” such as sunlight and UVB radiation, Lebwohl and colleagues wrote.

All other nations showed lower proportions of non-celiac gluten sensitivity compared with the U.S., with Argentina showing the lowest (94.7% vs. 5.3%; P < .0001). Asia, Eastern and Western Europe, the Netherlands and Germany all showed statistically similar ratios to the U.S., while Italy, the U.K. and Spain all showed higher rates of celiac disease.

“Non-celiac avoiders of gluten were more likely to report additional food intolerances, such as to dairy, eggs and soy,” Lebwohl said.

Overall, 25% of all respondents reported they avoided foods other than gluten, and this was significantly more common among respondents with non-celiac gluten sensitivity (P < .0001).

“This remains a phenomenon that needs our attention and study,” Lebwohl said. “We also found a correlation worldwide between wealth (GDP per capita) and the proportion of respondents without celiac disease,” he added.

This finding could be explained by the high cost of gluten-free products, or by varying interest in or awareness of the Nima device, he and colleagues wrote.

They concluded that future research should further evaluate the causes of these differences, and the significance of avoiding other foods in this population. – by Adam Leitenberger

Disclosures: Two of the researchers report they are employed by Nima Labs.

Benjamin Lebwohl, MD, MS
Benjamin Lebwohl

Relative proportions of celiac disease and non-celiac gluten sensitivity among individuals who avoid dietary gluten vary significantly across the U.S. and the world, according to new research.

More than a quarter of survey respondents (28.6%) avoided gluten due to self-reported non-celiac gluten sensitivity, researchers noted.

“Despite the marked rise in practice of avoiding gluten in recent years, our understanding of the epidemiology of this phenomenon (the where and the why) remains limited,” Benjamin Lebwohl, MD, MS, director of clinical research at The Celiac Disease Center at Columbia University, told Healio Gastroenterology.

To better understand reasons for gluten avoidance, Lebwohl and colleagues evaluated responses to a questionnaire on the website for the Nima sensor (Nima Labs), a portable device for detecting gluten in food. They assessed data provided by individuals with either celiac disease (n = 6,474) or non-celiac gluten sensitivity (n = 2,597) from 15 global regions and four U.S. regions.

“We found that among people interested in a gluten-detection device, the relative frequency of non-celiac patients was greatest in the U.S., and within the U.S. it was highest in Western states,” Lebwohl said.

Most respondents in the U.S. did report having celiac disease (69.8%). The Northeast showed the highest ratio of celiac disease vs. non-celiac gluten sensitivity (74.3% vs. 25.7%), while the West showed the lowest (67.1% vs. 32.9%; P < .0001). These regional differences “are likely related to an interplay of genetic and environmental factors,” such as sunlight and UVB radiation, Lebwohl and colleagues wrote.

All other nations showed lower proportions of non-celiac gluten sensitivity compared with the U.S., with Argentina showing the lowest (94.7% vs. 5.3%; P < .0001). Asia, Eastern and Western Europe, the Netherlands and Germany all showed statistically similar ratios to the U.S., while Italy, the U.K. and Spain all showed higher rates of celiac disease.

“Non-celiac avoiders of gluten were more likely to report additional food intolerances, such as to dairy, eggs and soy,” Lebwohl said.

Overall, 25% of all respondents reported they avoided foods other than gluten, and this was significantly more common among respondents with non-celiac gluten sensitivity (P < .0001).

“This remains a phenomenon that needs our attention and study,” Lebwohl said. “We also found a correlation worldwide between wealth (GDP per capita) and the proportion of respondents without celiac disease,” he added.

This finding could be explained by the high cost of gluten-free products, or by varying interest in or awareness of the Nima device, he and colleagues wrote.

They concluded that future research should further evaluate the causes of these differences, and the significance of avoiding other foods in this population. – by Adam Leitenberger

Disclosures: Two of the researchers report they are employed by Nima Labs.