3 August 2011: One of Africa’s and Asia’s biggest public health problems has had greater light shed on it through a study undertaken by researchers at Wits University and Umea University, Sweden, who have compiled the first global estimates of coeliac disease and associated mortality.
Their findings, published in the journal PLoS ONE, estimates that around 42 000 children may die every year from coeliac disease, mostly from the African and Asian continents.
Coeliac disease is an auto-immune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. It is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in other common grains such as barley and rye.
In the 1930s, before the discovery of the gluten-free diet as the way to manage coeliac disease, results from Great Ormond Street Hospital in London1 showed very high mortality among children with coeliac disease. Mostly these days, the disease is well-managed by avoiding gluten. However in poorer settings, particularly where other diarrhoeal diseases are common, questions about gluten intolerance may not be raised, and consequently children may die.
“Coeliac disease may not be one of the world’s biggest killers, but it is a readily preventable cause of death. Much more awareness is needed in the poorer parts of the world – and in particular gluten-bearing food supplements for malnourished children need to be used in the knowledge that they could be harmful to the small proportion suffering from coeliac disease,” says Prof. Peter Byass, research team leader from the Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine at Umeå University.
Coeliac disease has emerged as an increasingly recognised public health problem over the last half-century, and is now seen as a global phenomenon, despite a profound lack of globally representative epidemiological data. Since children with coeliac disease commonly present with chronic diarrhoea and malnutrition, diagnosis is often overlooked, particularly in poorer settings where children often fail to thrive and water-borne infectious diarrhoeas are common. This is the first attempt to make global estimates of the burden of coeliac disease in childhood.
Building a model of childhood coeliac disease, the researchers took into account estimates of population prevalence, probability of non-diagnosis, and likelihood of mortality among the undiagnosed across all countries from 1970 to 2010, based around the few available data.
According to the model, in 2010 there were around 2.2 million children under five years of age living with coeliac disease. Among these children there could be 42 000 deaths related to coeliac disease annually. In 2008, deaths related to coeliac disease probably accounted for approximately 4% of all childhood diarrhoeal mortality.
The researchers found that although coeliac disease may only account for a small proportion of diarrhoeal mortality, these deaths are not preventable by applying normal diarrhoea treatment guidelines, which may even involve gluten-based food supplements. As other causes of diarrhoeal mortality decline, coeliac disease will become a proportionately increasing problem unless consideration is given to trying gluten-free diets for children with chronic diarrhoea and malnutrition.
The authors hope that increased awareness of the consequences of gluten intolerance will lead to better data and the saving of lives in the future.
To read the paper in PLoS one, click here
For further information contact Professor Kathleen Kahn at Kathleen.Kahn@wits.ac.za
Source: http://www.wits.ac.za/newsroom/newsitems/201108/13452/news_item_13452.html
