Celiac disease (CeD) is a chronic autoimmune disorder that is triggered by gluten exposure in genetically susceptible individuals, usually with human leukocyte antigen (HLA)-DQ2 or DQ8 alleles. It affects approximately 1% of the global population. Diagnosis of CeD can be challenging due to atypical or extra-intestinal manifestations and relies on positive serology for anti-tTG-IgA antibodies combined with evidence of intestinal pathology. CeD presents with a risk of malabsorption and lack of proper nutrition, causing symptoms like diarrhea, anaemia, and weight loss.
Vitamins and trace elements are not needed in large amounts. However, they are still important for health and are often deficient in patients with CeD, possibly due to intestinal inflammation. Deficiency of vitamins and trace elements contributes to disease progression and hinders recovery.
Although it has been identified that micronutrients can affect CeD’s pathogenesis, the available data differ according to regions and diet, which underscores the need for localized studies. Xinjiang, China, with its wheat-based diet and diverse population, provides an excellent scope for celiac disease studies. Reports from that region show a prevalence of 2.53% in study subjects with gastrointestinal symptoms, with a higher prevalence among the Kazakh and Uygur groups compared to the Han Chinese subjects.
This cross-sectional study enrolled 59 patients with newly diagnosed celiac disease and 59 matched healthy controls in Xinjiang from February to December 2024. Celiac disease diagnosis was based on positive anti-tTG IgA (>20 IU/mL) and Marsh grade ≥2. Researchers measured 17 vitamins and 10 trace elements using LC-MS, as well as BMI, hemoglobin, and albumin. Additional testing for CeD patients included Marsh grade and tTG-IgA levels. Statistical analyses were performed using t-test, Wilcoxon, and chi-square analysis, with a significance level at p <0.05.
Among the 59 celiac patients, 80% were female, and the mean BMI was 23.0 ± 5.7. The most common symptoms were abdominal pain (53%), followed by nausea and vomiting (46%), and diarrhea (39%). Based on symptoms, 39% derived classical CeD (with consumption symptoms like diarrhea), and the remaining were non-classical. Compared to controls, CeD patients had significantly lower BMI (p <0.05), hemoglobin (p <0.01), and albumin (p <0.01).
Patients with CeD had significantly lower levels of vitamin A, E, K2 (MK-7), and B7 than healthy controls (p <   0.01) and lower levels of vitamin K2 (MK-4), vitamin B6, and zinc (p < 0.05). CeD patients had greater rates of deficiency for vitamin A (86% vs. 66%, p <0.05), vitamin E (31% vs. 12%, p <0.05), and vitamin K2 (MK-7) (27% vs. 5%, p <0.01). CeD patients also had significantly higher levels of vitamin B3 (p <0.05) and chromium (p < 0.01), and excessive rates of vitamin B3 were found in 75% of CeD patients compared to 51% of controls (p <0.05).
Further, analysis revealed correlations between certain micronutrient levels and clinical indications of disease severity. Vitamin C, iron, and calcium levels were also negatively correlated with Marsh classification, indicating greater deficiencies with severe intestinal damage.
Similarly, serum levels of vitamin D and vitamin E showed a negative correlation with anti-tTG IgA levels, suggesting that stronger immune responses may coincide with greater vitamin deficiencies. Vitamin A levels in patients with classical gastrointestinal symptoms like diarrhoea were significantly lower than levels in those with predominantly extra-intestinal symptoms, thus reinforcing the relationship between symptom severity and nutrient depletion.
This study indicates that many adults with newly diagnosed CeD in Xinjiang present with multiple micronutrient imbalances, including deficiencies in specific vitamins and minerals and increased levels of vitamin B3 and chromium. These findings underscore the importance of early nutritional assessment and ongoing monitoring to improve patient outcomes and prevent complications.
References: Nuermaimaiti K, Li T, Li N, et al. Vitamin and trace elements imbalance are very common in adult patients with newly diagnosed celiac disease. Sci Rep. 2025;15:28315. doi:10.1038/s41598-025-12631-1
