{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T04:22:26Z","timestamp":1774585346259,"version":"3.50.1"},"reference-count":52,"publisher":"BMJ","issue":"10","funder":[{"name":"CIHR Doctoral Research Award"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,8,9]]},"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Coeliac disease (CD) is a complex autoimmune disorder with known genetic risk factors. Approximately 1% of individuals of European ancestry have CD, but the prevalence among different ethnicities living in Canada remains unknown. The objective of the present study was to determine the prevalence of positive CD serology in a population of Canadian adults living in Toronto, and to determine whether the prevalence of CD seropositivity and predisposing human leucocyte antigen (HLA)-DQ2\/DQ8 risk genotypes differ between major ethnocultural groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross-sectional screening study of participants from the Toronto Nutrigenomics and Health and the Toronto Healthy Diet studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>University campus and households across Toronto, Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants: free-living<\/jats:title><jats:p>Adults (n=2832) of diverse ethnocultural backgrounds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Prevalence of positive CD serology was determined by screening for antitissue transglutaminase antibodies in individuals with predisposing HLA-DQ2\/DQ8 genotypes. HLA genotypes were determined using six single nucleotide polymorphisms in the HLA gene region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2832 individuals screened, a total of 25 (0.88%; 95%\u2009CI 0.57% to 1.30%) were determined to have positive CD serology. The majority of seropositive CD cases were undiagnosed (87%). Prevalence was highest among Caucasians (1.48%; 95%\u2009CI 0.93% to 2.23%), and similar in those of \u2018Other\u2019 (0.74%; 95%\u2009CI 0.09% to 2.63%) or \u2018Unknown\u2019 (0.43; 95%\u2009CI 0.01% to 2.36%) ethnicity. No cases of positive CD serology were identified among East Asian or South Asian individuals. East Asians had a lower prevalence of HLA risk genotypes than Caucasians and South Asians (p&lt;0.005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The prevalence of positive CD serology among Canadian adults living in Toronto is likely ~1%, with 87% of cases being undiagnosed. These findings suggest the need for better screening in high genetic risk groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>NCT00516620; Post-results.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2017-017678","type":"journal-article","created":{"date-parts":[[2017,10,7]],"date-time":"2017-10-07T00:55:21Z","timestamp":1507337721000},"page":"bmjopen-2017-017678","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence of positive coeliac disease serology and HLA risk genotypes in a multiethnic population of adults in Canada: a cross-sectional study"],"prefix":"10.1136","volume":"7","clinical-trial-number":[{"clinical-trial-number":"nct00516620","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Joseph","family":"Jamnik","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R","family":"Villa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirbarinder Bryn","family":"Dhir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J A","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"El-Sohemy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,10,6]]},"reference":[{"key":"2024051614453659000_7.10.bmjopen-2017-017678.1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jaut.2015.07.003","article-title":"The genetics of celiac disease: A comprehensive review of clinical implications","volume":"64","author":"Dieli-Crimi","year":"2015","journal-title":"J Autoimmun"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0198-8859(03)00027-2"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2009.05.028"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra071600"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.5","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i42.6036"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.6","doi-asserted-by":"publisher","DOI":"10.1128\/CVI.00568-12"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0093180","article-title":"Serological assessment for celiac disease in IgA deficient adults","volume":"9","author":"Wang","year":"2014","journal-title":"PLoS One"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.8","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-07-031104"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.9","doi-asserted-by":"publisher","DOI":"10.1172\/JCI30253"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.10","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3109\/07853890.2013.849383","article-title":"Appropriate nutrient supplementation in celiac disease","volume":"45","author":"Caruso","year":"2013","journal-title":"Ann Med"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.01682.x"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.12","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmu007"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.13","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.02.027"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.14","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.03.059"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.15","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.3.286"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-014-3514-7"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.17","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2010.505931"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.18","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12373"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.19","doi-asserted-by":"crossref","first-page":"1716-1717","DOI":"10.1001\/jamainternmed.2016.5254","article-title":"Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014","volume":"176","author":"Kim","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2007.03502.x"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.21","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.60"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.22","doi-asserted-by":"crossref","unstructured":"Fukunaga M , Ishimura N , Fukuyama C , et al . Celiac disease in non-clinical populations of Japan. J Gastroenterol 2017.doi:10.1007\/s00535-017-1339-9","DOI":"10.1007\/s00535-017-1339-9"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0157510","article-title":"Celiac Disease Autoimmunity in Patients with Autoimmune Diabetes and Thyroid Disease among Chinese Population","volume":"11","author":"Zhao","year":"2016","journal-title":"PLoS One"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.24","doi-asserted-by":"crossref","unstructured":"Yuan J , Zhou C , Gao J , et al . Prevalence of Celiac Disease Autoimmunity Among Adolescents and Young Adults in China. Clin Gastroenterol Hepatol 2017.doi:10.1016\/j.cgh.2017.04.025","DOI":"10.1016\/j.cgh.2017.04.025"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/ajg.2015.398","article-title":"Prevalence of Adult Celiac Disease in India: Regional Variations and Associations","volume":"111","author":"Ramakrishna","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2009.05932.x"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.27","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1111\/jgh.13270","article-title":"Prevalence of celiac disease in Asia: A systematic review and meta-analysis","volume":"31","author":"Singh","year":"2016","journal-title":"J Gastroenterol Hepatol"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.28","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.111.022657"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.089"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0002270","article-title":"Effective detection of human leukocyte antigen risk alleles in celiac disease using tag single nucleotide polymorphisms","volume":"3","author":"Monsuur","year":"2008","journal-title":"PLoS One"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.31","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200605000-00006"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.32","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.276"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2015.04.049"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.34","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1097\/MPG.0000000000001351","article-title":"Lack of Utility of Anti-tTG IgG to Diagnose Celiac Disease When Anti-tTG IgA Is Negative","volume":"64","author":"Absah","year":"2017","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.35","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1001\/jamapediatrics.2013.3858","article-title":"Celiac disease: a review","volume":"168","author":"Guandalini","year":"2014","journal-title":"JAMA Pediatr"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.36","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.219"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.37","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-006-9258-2"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.38","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.i15.2153"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.39","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1155\/2003\/789139","article-title":"Biopsy-defined adult celiac disease in Asian-Canadians","volume":"17","author":"Freeman","year":"2003","journal-title":"Can J Gastroenterol"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.40","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1159\/000201035","article-title":"High risk of coeliac disease in Punjabis. Epidemiological study in the south Asian and European populations of Leicestershire","volume":"54","author":"Sher","year":"1993","journal-title":"Digestion"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.41","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2006.04281.x"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.42","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1097\/00042737-200505000-00011","article-title":"Coeliac disease in South Asians resident in Britain: comparison with white Caucasian coeliac patients","volume":"17","author":"Butterworth","year":"2005","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.43","doi-asserted-by":"crossref","first-page":"e1779","DOI":"10.1097\/MD.0000000000001779","article-title":"Serological Screening for Celiac Disease in Adult Chinese Patients With Diarrhea Predominant Irritable Bowel Syndrome","volume":"94","author":"Wang","year":"2015","journal-title":"Medicine"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.44","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.19.2343"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.45","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1400697"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.46","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1056\/NEJMoa1404172","article-title":"Randomized feeding intervention in infants at high risk for celiac disease","volume":"371","author":"Vriezinga","year":"2014","journal-title":"N Engl J Med Overseas Ed"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.47","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-12-194"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.48","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00741.x"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2014.03.011"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.50","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1038\/nrgastro.2015.90","article-title":"Novel players in coeliac disease pathogenesis: role of the gut microbiota","volume":"12","author":"Verdu","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.51","doi-asserted-by":"publisher","DOI":"10.1126\/science.1208344"},{"key":"2024051614453659000_7.10.bmjopen-2017-017678.52","doi-asserted-by":"publisher","DOI":"10.3148\/72.3.2011.e161"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-017678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T21:45:56Z","timestamp":1715895956000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-017678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2017,10,6]]},"published-print":{"date-parts":[[2017,10]]}},"alternative-id":["10.1136\/bmjopen-2017-017678"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-017678","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10]]}}}