Abstract
ObjectivesCoeliac disease has emerged as an increasingly recognised public health problem over the last half-century, and is now coming to be 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.MethodsWe built a relatively crude model of childhood coeliac disease, incorporating 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. All our assumptions are stated in the paper and the model is available as a supplementary file.FindingsOur model suggests that in 2010 there were around 2.2 million children under 5 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.ConclusionsAlthough 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.
Highlights
Over the last half-century, research has increasingly revealed the nature and extent of coeliac disease, among European populations, but there remains much to be learnt about this disease on a global scale [1,2,3]
Conclusions: 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
Summary
Over the last half-century, research has increasingly revealed the nature and extent of coeliac disease, among European populations, but there remains much to be learnt about this disease on a global scale [1,2,3]. Coeliac disease is a systemic autoimmune syndrome involving a gluten-induced chronic inflammation of the small bowel mucosa, with extensive shortand long term negative health consequences if untreated [4]. Adopting a gluten-free diet, either following clinical diagnosis or in response to symptoms, resolves coeliac disease enteropathy, and thereby eliminates associated health risks. From a public health perspective, the at-risk group comprises those living with coeliac disease that is not diagnosed as such
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