乳糜泻是一种全球性疾病,需要遗传易感性和麸质暴露才能引发免疫介导的肠病。含麸质谷物利用率对乳糜泻患病率的影响尚不清楚。我们的目标是使用系统的文献综述比较基于国家的面筋可用性与乳糜泻患病率。我们搜索了MEDLINE,Embase,科克伦,和Scopus,直到2021年5月。我们纳入了基于人群的血清筛查和确证试验(第二次血清学研究或小肠活检),并排除了特异性,高风险,或转诊人群。我们使用联合国小麦的粮食平衡来确定特定国家的面筋供应,大麦,还有黑麦.人类白细胞抗原(HLA)频率从等位基因频率获得。主要结果是含麸质谷物的可用性与乳糜泻患病率之间的关联。采用泊松链接的广义线性混合模型方法进行分析。我们确定了5641篇文章,纳入了来自41个国家的427.146受试者的120项研究。乳糜泻患病率为0-3.1%,中位数0.75%(四分位数间隔0.35,1.22)。小麦供应中位数为人均246克/天(四分位数间距214.8,360.7)。乳糜泻小麦有效性的风险比(RR)为1.002(95%置信区间[CI]:1.0001,1.004,P=0.036)。大麦有保护性联系,RR0.973(95%CI:0.956,0.99,P=0.003),还有黑麦,RR0.989(95%CI:0.982,0.997,P=0.006)。国内生产总值对乳糜泻患病率的RR为1.009(95%CI:1.005,1.014,P<0.001)。HLA-DQ2的RR为0.982(95%CI:0.979,0.986,P<0.001),HLA-DQ8为0.957(95%CI:0.950,0.964,P<0.001)。在这项地理流行病学研究中,含麸质谷物的可用性显示与乳糜泻患病率混合相关。
Celiac disease is a global disease requiring genetic susceptibility and gluten exposure to trigger immune-mediated enteropathy. The effect of the degree of gluten-containing grain availability on celiac disease prevalence is unknown. Our objective was to compare country-based gluten availability to celiac prevalence using a systematic literature
review. We searched MEDLINE, Embase, Cochrane, and Scopus until May 2021. We included population-based serum screening with confirmatory testing (second serological study or small intestine biopsy) and excluded specific, high-risk, or referral populations. We determined country-specific gluten availability using the United Nations food balance for wheat, barley, and rye. Human leukocyte antigen (HLA) frequencies were obtained from allelefrequencies.net. The primary outcome was association between gluten-containing grain availability and celiac disease prevalence. Generalized linear mixed models method with Poisson\'s link was used for analysis. We identified 5641 articles and included 120 studies on 427 146 subjects from 41 countries. Celiac disease prevalence was 0-3.1%, median 0.75% (interquartile range 0.35, 1.22). Median wheat supply was 246 g/capita/day (interquartile range 214.8, 360.7). The risk ratio (RR) for wheat availability on celiac disease was 1.002 (95% confidence interval [CI]: 1.0001, 1.004, P = 0.036). A protective association was seen with barley, RR 0.973 (95% CI: 0.956, 0.99, P = 0.003), and rye, RR 0.989 (95% CI: 0.982, 0.997, P = 0.006). The RR for gross domestic product on celiac disease prevalence was 1.009 (95% CI: 1.005, 1.014, P < 0.001). The RR for HLA-DQ2 was 0.982 (95% CI: 0.979, 0.986, P < 0.001), and that for HLA-DQ8 was 0.957 (95% CI: 0.950, 0.964, P < 0.001). In this geo-epidemiologic study, gluten-containing grain availability showed mixed associations with celiac disease prevalence.