Evaluation of Serum Levels of Copper and Zinc in Patients with Celiac Disease Seropositivity: Findings from the National Health and Nutrition Examination Survey.

Abstract

Celiac disease is a multisystem immune based disorder, caused by an immune-mediated reaction to ingested gluten with increasing prevalence in the USA. Celiac disease can cause a wide variety of symptoms, including gastrointestinal symptoms (diarrhea, abdominal distention, or abdominal pain), which may affect absorption of many nutritional components. All patients with celiac disease should remain on a strict and lifelong gluten-free diet, which are often low in certain trace elements such as zinc. On the other hand, zinc and copper as the essential trace elements have been hypothesized to help maintain optimum function of the immune system. Then, this study aims to examine the association between celiac disease seropositivity and serum zinc and copper levels. A nationally representative sample from National Health and Nutrition Examination Survey (2011-2014) was analyzed. Celiac disease seropositivity was determined using the tissue transglutaminase IgA antibody test (IgA-TTG). Multivariable linear regression models were performed with celiac disease seropositivity as a predictor and serum zinc and copper levels as outcome. The present study included 4732 participants (1398 children aged 6-19years and 3334 adults aged ≥ 20years). The weighted prevalence of celiac disease seropositivity was higher (11.6/1000) among children aged 6-19years compared to that (6.3/1000) among adults aged ≥ 20years. In the stratified analysis by age, the multivariable linear regression analysis revealed that among children aged 6-19years, celiac disease seropositivity was associated with 5.32 (95% CI, - 9.71 to - 0.92) μg/dL lower serum zinc level, but not associated with serum copper level. However, the association between celiac disease seropositivity and serum zinc level was not statistically significant among adults aged 20years or older. Future prospective studies are warranted to confirm these findings.