Monday, May 9, 2011
THE BURDEN OF CELIAC DISEASE IN THE MEDITERRANEAN AREA, 5B EU/year!
We really need to get more celiac's diagnosed to reduce the global financial, social, individual costs of celiac disease.
According to Luigi Greco (coordianator), European Laboratory for Food Induced Diseases (ELFID), Naples, Italy, Europe and the Middle East is not prepared for the burden of CELIAC DISEASE.
-the incidence is 1-44%( in at risk groups)
-the rate of undiagnosed is very high ranging from 7- 13 not diagnosed for everyone diagnosed. Some say 3% only are diagnosed.
-health care costs of an undiagnosed celiac is astronomical, being estimated at more than 5 Billions Euro/year.
-and health care costs are reported to decrease by 30% after diagnosis.
-death rate's for celiac's is 1.8 or almost double.
The aim of his teams work is to estimate the global burden related to undiagnosed Celiac disease in the Mediterranean Area, as computed by morbidity, mortality and crude health cost.
Recent epidemiological studies show that the prevalence of Celiac disease (CD) had been underestimated, affecting not only Europeans, but also populations of the Mediterranean countries, such as Middle East (1-4) and North Africa(5-7), where its prevalence is similar to that of Western countries. Now CD appears to be a widespread public health problem, involving also the population of developing countries as well as of China (8,9,14).
In the Northern Africa Region and in the Middle East very high incidence of CD has recently been reported both in the general population and in at risk-group. These high frequencies are due to the wide consumption of wheat and barley and to the high frequency of the DR3-DQ2 CD predisposing haplotypes in these population (13,14). Prevalence of CD among low risk populations varies from 0,14% to 1,17% (15-17): 1%-1,3% in Turkey (18,19), 0,6%-0,96% in Iran (20-21), 0,5% in Egypt (22), 0,6% in Tunisia and Israel (23-24), <0,5% in Jordan, Lebanon, and Kuwait (1,10,16,25). Among high risk groups (patients with positive family history, insulin dependent diabetes mellitus, thyroiditis, etc) the prevalence of CD ranges from 2,4% to 44% assessed by serological markers and biopsy (26-27).
The use of wheat and other gluten-containing cereals is spreading all over the world, the consumption of wheat based pasta is increasing in Europe but also across Mediteranneum, where many countries are big producers also. The Italian nutritional style associated with the healthy features of the Mediterranean Diet was the cultural background supporting the widespread diffusion of the pasta. Unfortunately the side effect of this positive move has been the enormous increase of gluten intolerance.
Robust estimates of a prevalence of 1:100 individuals result in more than 5 millions individuals from the Euro-Mediterranean Countries affected by permanent gluten intolerance (Celiac Disease).
We also are aware that less than 1 every 7 adult individual and less than 1: 5 children affected are correctly diagnosed and treated (1,10-12). In the next 10 years we have to face about 5 millions cases in the Mediterranean area. This is the largest global epidemic of food-induced permanent disease in the area.
The health toll of this ‘epidemic’ unfortunately includes growth failure, infant malnutrition, gastrointestinal diseases, anemia and more than 20 associated symptoms and conditions. The risk of cancer in undiagnosed adults is significantly increased and the mortality is doubled in the total cohort of affected (28-33). The financial burden of this specific food related problem has to be estimated to more than 5 Billions Euro/year.
Very few countries from the Euro-Mediterranean Region are able to face this expanding problem : in many countries few cases are recognized, because of the low awareness and know-how to deal with the problem.
The diagnosis of CD brought a 30% reduction in direct medical expenditure. A similar 30% reduction in direct medical cost after diagnosis of CD was also reported by Green (35, 36).
There is more interesting information, including the references here: