We analyzed serum samples from white men (¡Ý25 y) and women (¡Ý50 y) who participated in the Hemochromatosis and Iron Overload Screening study; cases were defined as individuals with iron deficiency (serum ferritin level, ¡Ü12 ¦Ìg/L) and controls were those without (serum ferritin level, >100 ¦Ìg/L in men and >50 ¦Ìg/L in women). All samples also were analyzed for human recombinant tissue transglutaminase immunoglobulin A; positive results were confirmed by an assay for endomysial antibodies. Patients with positive results from both celiac disease tests were presumed to have untreated celiac disease, and those with a positive result from only 1 test were excluded from analysis. We analyzed HLA genotypes and frequencies of celiac disease between Caucasians and non-Caucasians with iron deficiency.
Celiac disease occurred in 14 of 567 cases (2.5 % ) and in only 1 of 1136 controls (0.1 % ; Fisher exact test, P = 1.92 ¡Á 10?6). Celiac disease was more common in Caucasian cases (14 of 363; 4 % ) than non-Caucasian cases (0 of 204; P = .003). Only 1 Caucasian control and no non-Caucasian controls had celiac disease. The odds of celiac disease in individuals with iron deficiency was 28-fold (95 % confidence interval, 3.7-212.8) that of controls; 13 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype.
Celiac disease is associated with iron deficiency in Caucasians. Celiac disease is rare among non-Caucasians¡ªeven among individuals with features of celiac disease, such as iron deficiency. Celiac disease also is rare among individuals without iron deficiency. Men and postmenopausal women with iron deficiency should be tested for celiac disease.