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Consumption of Wheat Foodstuffs Not A Risk for Celiac Disease Occurrence in Burkina Faso

2002; Lippincott Williams & Wilkins; Volume: 35; Issue: 2 Linguagem: Inglês

10.1097/00005176-200208000-00029

1536-4801

F Cataldo, Domenico Lio, Jacques Simporé, Salvatore Musumeci,

Food composition and properties

To the Editors: During the past few years, the incidence of celiac disease has been researched systematically in the Western World, and a very high prevalence has been found (1,2). However, few studies have looked at the prevalence of celiac disease in the developing countries, which in some countries is rare (3) and surprisingly endemic in others (4). These changes in the incidence of a disease of genetically predisposed individuals may relate to environmental factors, for example, different alimentary habits, since wheat foodstuff are not the staple aliments in all developing countries. Moreover, it is not clear whether celiac disease is rare in developing countries because of a lack of predisposing genes or whether the genes are not expressed because wheat foodstuffs are not consumed traditionally. However, these populations have serious problems of malnutrition because of poor and inadequate diets or recurrent gastrointestinal infections. Recently, Western countries have tried to help these less fortunate populations by sending wheat foodstuffs; therefore, exposure to gluten food potentially could induce celiac disease in these populations if they are predisposed genetically to gluten intolerance. The Mossi (total population, approximately 5 million), one of the three great ethnic groups in Burkina Faso, live in the central plateau of Burkina Faso (formerly Upper Volta). They rode north from what is now northern Ghana into the basin of the Volta River and conquered several less powerful people, including the Dagon, Lela, Nuna, and Kurumba. They speak Moré, a language akin to that spoken by the Mamprusi and the Dagombe. In 1897, the first French military explorers arrived in the area and staked French colonial claims. The Mossi are primarily sedentary farmers, raising millet, sorghum maize, sesame, peanuts, and indigo as staples of their diet. During the colonial period, the French exercised a policy of deliberate underdevelopment intended to force Mossi laborers to leave their homes after the harvest and to migrate along the French-built railroad to Cote d'Ivoire where they worked in French-owned factories and plantations. The direct consequence of these changes was that wheat foodstuff alimentation has become more common than in the past. Because Mossi recently have introduced wheat foodstuff to their diets, we evaluated the potential risk for the Mossi to develop celiac disease within a project of cooperation between the Sardinian Tegion and the Centre Medical St. Camille, Ouagadougou, Burkina Faso. IgA antiendomysial antibodies (EMA) were examined using indirect immunofluorescence of monkey esophagus sections (Endomisio Eurospital, Trieste, Italy) and antitransglutaminase antibodies of the guinea pig were examined using a commercial ELISA kit (Eu-tTG Eurospital, Trieste, Italy). At the same time, the HLA alleles that confer susceptibility to celiac disease (DQA1 and DQB1) also were examined using PCR and sequence-specific primers (5). Subsequently, 600 blood samples from unrelated and randomly selected subjects (277 male and 323 female subjects, aged from 15 to 53 years) were studied to evaluate susceptibility to gluten intolerance among the Mossi. In the past, all subjects had consumed wheat or wheat products, but anamnestically none had experienced chronic diarrhea, growth retardation, abdominal distention, or other symptoms that suggest typical or atypical celiac disease. Blood samples were collected from all subjects for serologic tests (EMA, anti-tTG, and serum IgA), and a group of 85 subjects, randomly selected, also were typed for HLA DQA1 and DQB1. Informed consent was obtained from all subjects under study for clinical, serologic and genetic surveys. None of the subjects tested positive for EMA or anti-tTG, and one showed serum IgA deficit. Table 1 shows the most common HLA alleles: in the DQA1* locus, DQA1*01 followed by DQA1*04 and DQA1*02; and in the DQB1* locus, DQB1*03 followed by DQB1*06, DQB1*05, DQB1*02, and DQB1*04. Regarding the celiac disease susceptibility alleles, DQA1*0501 was found in 5 of 85 subjects, DQA1*0301 in 6 of 85, DQB1*0201 in 4 of 85, DQB1*0202 in 9 of 85, and DQB1*0302 in 4 of 85. The analysis of the DQA1*/DQB1* allele combination identified only one subject bearing both DQA1*0301 and DQB1*0302 alleles (coding for HLA-DQ8 serologic specificity), whereas the DQA1*0501/DQB1*02 combinations were not detected.TABLE 1: Percentage distribution of DQA1 and DQB1 specificity among 85 subjects from Mossi population*As a whole, these serologic and immunogenetic data suggest that the risk for celiac disease among the Mossi people is quite minimal. Gluten consumption has not triggered antibody response with production of EMA and anti-tTG, which have almost 100% sensitivity and specificity for celiac disease. The very low risk of celiac disease in the Mossi population is in marked contrast with a Saharan population of Arab descendants with a very high frequency of celiac disease, as described by Catassi et al. (4) in 1999. The reason for the absence of a celiac serologic pattern among the Mossi may be related to their genetic background from the Dagombe of Northern Ghana. The introduction of wheat cultivation and gluten alimentation can induce production of autoantigens (i.e., EMA and anti-tTG) and consequently can induce celiac disease in genetically predisposed individuals when the gluten is appropriately presented to the T cells by the HLA-DQ alleles. Because these alleles seem to have a very low frequency among the Mossi, new dietary habits, such as consumption of wheat foodstuff, do not appear likely to trigger gluten intolerance among this ethnic group. Sending wheat foodstuffs to developing countries through Western humanitarian programs may induce risk for celiac disease and associated diseases (thyroiditis, diabetes, neuropathy, etc.) in countries where genetic factors have been documented. However, our preliminary studies open the way for wider distribution of Western wheat surpluses in a spirit of a global cooperation among all peoples. *Francesco Cataldo †Domenico Lio ‡Jacques Simpore §Salvatore Musumeci