Celiac Disease Around the World

Celiac Disease Around the World

Celiac disease was originally thought to almost exclusively affect white Europeans, it is now known to be widely distributed worldwide.

Celiac (coeliac) disease was originally thought to almost exclusively affect white Europeans, it is now known to be widely distributed worldwide. Studies show that in Europe and the USA and Australia around 1% of the population have coeliac disease.  Incidence has been shown to be increasing.

For every person diagnosed with coeliac disease, approximately 7 to 8 8 have the condition but remain undiagnosed. Celiac disease is common in India (esp. North India), Pakistan, the Middle East and North Africa, although lack of awareness and facilities for diagnosis means even fewer people are diagnosed.

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In the Far East and Sub-Saharan Africa celiac disease is still rarely diagnosed. However, the genes for celiac disease do exist in these populations, although less frequently. The genes HLA DQ2 / DQ8 plus exposure to wheat and other triggers need to be present for someone to develop celiac disease.  Further research is needed to determine the true incidence in SE Asian countries such as Singapore.

It is thought that celiac disease incidence is likely to increase as wheat consumption in countries such as Singapore, China and Japan has increased dramatically over the past few decades. Diets have tended to become more ‘westernised’ and less reliant on rice as the staple.

So why does celiac disease seem to be increasing?

One theory is that In terms of human evolution wheat is a relatively new addition to our diet. The current high prevalence is thought to be due to a chain of events that started about 10,000 years ago after wild wheat was grown and domesticated in the ‘fertile crescent’ of the Middle East. Prior to this humans originally fed on meat, fruit and vegetables, with no exposure to gluten-containing cereals. The cultivation and consumption of wheat spread reaching Northern Europe exposing more people to gluten.

Another theory is that the speeding up of the modern wheat bread-making process makes it less easily digestible. A long fermentation process allows the carbohydrates and gluten in the bread to be partially broken down making it easier to digest.


World perspective and celiac disease epidemiology. Catassi C et al. 2015

Systematic review: Worldwide variation in the frequency of coeliac disease and changes over time. Kang JY et al. 2013.

Celiac disease: prevalence, diagnosis, pathogenesis and treatment. Gujiral N et al. 2012.

Is adult celiac disease really uncommon in Chinese? Lin-ling Jiang et al. 2009

Bridget Marr RD

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