ArticleJournal of general internal medicine2026
Subtle Laboratory and Clinical Precursors of Celiac Disease in Young Adults: A Large-Scale Retrospective Cohort Study.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Age- and sex-specific patterns of microcytic anemia in adolescence: implications for screening.European journal of pediatrics · 2026Article
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10 authors.
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Abstract
BACKGROUND/
aimCeliac disease (CD) is frequently underdiagnosed in adults due to the absence of classic gastrointestinal symptoms, leading to delayed diagnosis and potential long-term complications. This study aimed to identify subtle clinical and laboratory indicators preceding CD diagnosis in young adults (18-40 years). METHODOLOGY: A retrospective cohort study was conducted using data from over 430,000 members of Clalit Health Services. Incident CD cases were identified by an ICD-9 code and a positive serological test. Laboratory values were analyzed for trends up to 7 years prior to diagnosis, and "relative" abnormalities were defined based on medians of diagnosed CD patients. Cox proportional hazards regression was used to assess the association between various pre-diagnostic clinical, laboratory, factors and the risk of CD diagnosis for 10 years.
resultsRelative lower hemoglobin and MCV in males and females were associated with CD with HR of 2.15 (1.43-3.22) and 5,519 (4.41-7.41) respectively. Liver enzymes (ALT more than 22 U/L in females and 27 U/L in males), and lower BMI even within the normal range, were significantly associated with an increased risk of later CD diagnosis with HR of 1.881 (1.29-2.75) for women and 2.919 (1.81-4.71) for males. These subtle laboratory and BMI findings were observable as early as 7 years before formal diagnosis. Additionally, chronic gastrointestinal symptoms and chromosomal risk factors significantly preceded CD diagnosis.
conclusionEarly recognition of subtle indicators like low normal hemoglobin, elevated liver enzymes, and lower BMI, alongside persistent GI symptoms and genetic predispositions, can enable timelier screening and diagnosis of CD in young adults, potentially mitigating long-term health consequences.
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