Celiac Disease and Non-Celiac Gluten Sensitivity
Several risk factors for celiac disease are well established:
- Race. Caucasians are generally at higher risk (Murray 2013; Lidums 2015; A.D.A.M. 2014).
- Gender. Among women, the prevalence is 1.5–2.8 times higher than among men (Fasano, Catassi 2012; Gujral 2012).
- Family history. First- and second-degree relatives of celiac patients have a 10- to 15-fold and a 2.5-fold increased risk, respectively, compared to the general population (Bai 2013; Silvester 2013; Fasano, Catassi 2012).
- Genetics. Positive HLA DQ2 and DQ8 genes are almost always present in celiac disease patients. Approximately 95% of celiac patients carry the HLA DQ2 gene, while the remainder express the HLA DQ8 gene. Without one of these gene variants, celiac disease is extremely rare and unlikely (Sapone 2012; Denham 2013; Fasano 2009).
- Early gluten exposure. Early introduction of gluten into an infant’s diet increases risk. There is a 5-fold increased risk in children fed gluten during their first three months of life; introduction of gluten to the diet of genetically susceptible infants should be delayed until the 4th to 6th month of life, and the mother should continue to breastfeed (Ferri 2015).
- Breastfeeding status. Not breastfeeding increases the risk of celiac disease in childhood, and breastfeeding is protective. Gradually introducing gluten-containing foods while breastfeeding decreases the risk up to 48%. It is not known whether breastfeeding prevents adult onset of celiac disease (Lidums 2015).
The risk factors for non-celiac gluten sensitivity are not currently known, though the condition is believed to occur more commonly in females and in young and middle age adults (Catassi 2013).