The patients were followed for a median of about seven to nine years, during which time there were 3,049 deaths among those with CD, 2,967 among those with inflammation, and 183 among the latent CD group. When the data was compared to records of the Swedish Total Population Register, all three groups had a higher risk of death than a matched control group; a 35 percent increased risk for those with latent CD, a 39 percent increased risk for those with CD, and a 72 percent increased risk for those with inflammation.

The risk of death was highest in the first year of follow-up, with latent CD associated with a 1.8-fold increased risk of death, CD with a 2.8-fold increase, and inflammation with a 4.7-fold increase. After the first year of follow-up, these figures decreased. The risk of death also decreased with age at diagnosis, with risk being higher for those diagnosed before age 20. “In conclusion, we found increased (risks) for death in individuals with biopsy-verified celiac disease, inflammation, and latent celiac disease, although absolute risks were small. Individuals undergoing small-intestinal biopsy in childhood had increased (risks) for death. Cardiovascular disease and malignancy were the main causes of death in celiac disease,” the authors write.

Jonas Ludvigsson, the study’s lead author and an associate professor of pediatrics at Orebro University Hospital, Sweden proposed several explanations for the increased mortality rates, including “malnutrition of energy and vitamins and chronic inflammation.” He said the higher risk in those with inflammation may because they weren’t told to follow a gluten-free diet, which often leads to normalization of the disease.

In an accompanying editorial, Dr. Peter H.R. Green, director of the Celiac Disease Center at Columbia University College of Physicians and Surgeons in New York, writes that the study provides important information on the risks associated with CD and raises the importance of doctors diagnosing the disease. “Until recently, gluten sensitivity has received little attention in the traditional medical literature, although there is increasing evidence for its presence in patients with various neurological disorders and psychiatric problems. The study by Ludvigsson and colleagues reinforces the importance of celiac disease as a diagnosis that should be sought by physicians. It also suggests that more attention should be given to the lesser degrees of intestinal inflammation and gluten sensitivity.”

According to the Celiac Sprue Association, about 1 of every 133 people has CD, but only about 3 percent have been diagnosed. Strict adherence to a gluten-free diet remains the only treatment for the disease, which can be very challenging since gluten can be found in everything from breakfast cereals and prepared luncheon meats to lip balms and lotions. Ingestion of gluten in any form can trigger CD to become active