Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis
- http://orcid.org/0000-0002-2713-8355Mohamed G Shiha1,2,
- Francesca Manza3,4,
- Oscar G Figueroa-Salcido5,
- Noé Ontiveros6,
- Giacomo Caio4,7,
- Claire L Jansson-Knodell8,
- http://orcid.org/0000-0001-6964-4072Alberto Rubio-Tapia8,
- Imran Aziz1,3,
- David S Sanders1,3
- 1 Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
- 2 Department of Gastroenterology, University Hospitals of Leicester NHS Trust, Leicester, UK
- 3 Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- 4 Department of Translational Medicine, St Anna Hospital, University of Ferrara, Ferrara, Italy
- 5 Nutrition Sciences Postgraduate Program, Autonomous University of Sinaloa, Culiacán, Mexico
- 6 Clinical and Research Laboratory (LACIUS, C.N., CONAHCYT National Laboratory, LANIBIOC), Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Faculty of Biological and Health Sciences, University of Sonora, Sonora, Mexico
- 7 Mucosal Immunology and Biology Research Centre, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- 8 Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Correspondence to Dr Mohamed G Shiha; mohamed.shiha1{at}nhs.net
Abstract
Background Non-coeliac gluten/wheat sensitivity (NCGWS) is characterised by gastrointestinal and extraintestinal symptoms related to gluten or wheat ingestion in individuals without coeliac disease or wheat allergy.
Objective A systematic review and meta-analysis was conducted to estimate the global burden and clinical characteristics of self-reported NCGWS.
Design We searched for studies evaluating the prevalence of self-reported NCGWS in the general population. Pooled prevalence estimates and odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using random-effects meta-analysis.
Results Twenty-five studies comprising 49 476 participants from 16 countries were included in the analysis. The pooled prevalence of self-reported NCGWS was 10.3% (95% CI 7.0% to 14.0%), with marked variations between countries. Among individuals reporting NCGWS, 40% (95% CI 25.2% to 55.0%) adhered to a gluten-free diet. The most common symptoms were bloating (71.0%; 95% CI 62.8% to 79.1%), abdominal discomfort (46.0%; 95% CI 39.0% to 52.7%), abdominal pain (36.0%; 95% CI 28.6% to 43.2%) and fatigue (32.1%; 95% CI 25.3% to 39.0%). Self-reported NCGWS was significantly more common in females than in males (OR 2.29; 95% CI 1.80 to 2.90; p<0.001). Individuals who self-reported NCGWS were significantly more likely to report anxiety (OR 2.95; 95% CI 1.56 to 5.57; p<0.001), depression (OR 2.42; 95% CI 1.80 to 3.24; p<0.001) and irritable bowel syndrome (OR 4.78; 95% CI 3.48 to 6.57; p<0.001) than controls.
Conclusion Approximately one in 10 people worldwide self-report NCGWS, with a female predominance and a significant association with psychological distress and irritable bowel syndrome. Our findings suggest positioning NCGWS within the spectrum of disorders of gut–brain interaction once organic pathologies have been excluded.
- GLUTEN
- IRRITABLE BOWEL SYNDROME
- COELIAC DISEASE
- GLUTEN FREE DIET
Data availability statement
Data are available upon reasonable request.
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