Nutritional Intake and Bone Health Among Adults With Probable Undiagnosed, Untreated Celiac Disease: What We Eat in America and NHANES 2009-2014.

The aim was to evaluate differences in nutritional intake of calcium, vitamin D, and phosphorus; serologic indices of these nutrients; and bone health among adults with and without probable, undiagnosed celiac disease (CD). Cross-sectional data from What We Eat in America and the National Health and Nutrition Examination Survey 2009-2014 including self-reported dietary and supplement intake from one day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry scans were analyzed in adults with probable undiagnosed CD, who tested positive on the immunoglobulin A endomysial antibody assay (n = 48) and controls (n = 13,634). Statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio. The prevalence of probable undiagnosed CD was 1 in 285. Probable CD status was associated with a 251.6 mg (95% confidence interval [CI], 72.3-432.9) higher daily total calcium intake. The total dietary and supplement intake of those with probable CD was significantly higher in calcium density (103.4 mg/1,000 kcal; 95% CI, 25.6-181.1) and phosphorus density (46.7 mg/1,000 kcal; 95% CI, 3.1-90.3). Probable CD status was associated with higher dairy consumption by 0.7 cups per day (95% CI, 0.2-1.2) and higher serum phosphorus concentrations (4.0 mg/dL vs 3.8 mg/dL,  = 0.011). No differences in serum calcium, vitamin D, or alkaline phosphatase levels were observed between groups. Probable CD status was also associated with a -0.1 g/cm (95% CI, -0.2 to -0.0) lower femur bone mineral density (BMD) and a -0.1 g/cm (95% CI, -0.1 to -0.0) lower femoral neck BMD. No differences in total spine BMD were observed. Adults with probable undiagnosed CD had lower bone density than adults without CD, despite also reporting higher total calcium intake and nutritional density of both calcium and phosphorus.