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Pinto-Sanchez MI, Blom JJ, Gibson PR, Armstrong D. Nutrition Assessment and Management in Celiac Disease. Gastroenterology 2024; 167:116-131.e1. [PMID: 38593924 DOI: 10.1053/j.gastro.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
Celiac disease (CeD) is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive and, like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is also associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity and metabolic complications, such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality at diagnosis and while on a long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a GFD.
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Affiliation(s)
- M Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jedid-Jah Blom
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter R Gibson
- Central Clinical School, Department of Gastroenterology, Monash University, Clayton, Victoria, Australia
| | - David Armstrong
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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Maniero D, Lorenzon G, Marsilio I, D'Odorico A, Savarino EV, Zingone F. Assessment of Nutritional Status by Bioelectrical Impedance in Adult Patients with Celiac Disease: A Prospective Single-Center Study. Nutrients 2023; 15:2686. [PMID: 37375589 DOI: 10.3390/nu15122686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The gluten-free diet [GFD] has been linked to an increased risk of weight gain and the development of metabolic disorders. Most of the studies have focused on the effect of GFD on the Body Mass Index [BMI]. We aimed to evaluate the nutritional status using specific nutritional parameters in patients with celiac disease [CeD] at diagnosis and on a GFD compared to healthy controls. We recruited subjects at our outpatient clinic at the University of Padua. We collected demographic and clinical data and values obtained with bioelectrical impedance analysis. A total of 24 CeD patients and 28 healthy controls were enrolled. CeD patients at diagnosis had a lower body cell mass index [BCMI, p = 0.006], fat-free mass index [FFMI, p = 0.02], appendicular skeletal muscle index [ASMI, p = 0.02], and phase angle [PA] [p < 0.001] compared to controls. Their percentage of extracellular water [ECW] was also higher [p < 0.001]. Considering CeD patients after GFD, nutritional status significantly improved after 6 months of GFD. We did not observe differences in BMI among groups [p = ns]. CeD patients at diagnosis were found to have a poorer nutritional status than healthy controls, with a positive effect of the GFD on their nutritional status, underlining the inefficacy of evaluating this aspect through only BMI evaluation.
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Affiliation(s)
- Daria Maniero
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35128 Padua, Italy
| | - Greta Lorenzon
- Gastroenterology Unit, Azienda Ospedale-Università Padova, 35128 Padua, Italy
| | - Ilaria Marsilio
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35128 Padua, Italy
| | - Anna D'Odorico
- Gastroenterology Unit, Azienda Ospedale-Università Padova, 35128 Padua, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35128 Padua, Italy
- Gastroenterology Unit, Azienda Ospedale-Università Padova, 35128 Padua, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35128 Padua, Italy
- Gastroenterology Unit, Azienda Ospedale-Università Padova, 35128 Padua, Italy
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Shi T, Feng Y, Li ZQ, Lu JJ, Abudurexiti A, Maimaitireyimu A, Hu JL, Wang M, Zhou HB, Abudureyimu A, Mei X, Guo XW, Liu WD, Gao F. Clinical presentation, biochemical profile, and HLA haplotype frequency of celiac disease among adults in Northwest China. J Dig Dis 2022; 23:506-515. [PMID: 36183167 DOI: 10.1111/1751-2980.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics, biochemical parameters and the distribution of HLA-DQ genotypes among adult patients with celiac disease (CD) in Northwest China. METHODS This cross-sectional study retrospectively collected clinical, biochemical, and HLA-DQ genotype of patients with CD from a tertiary hospital in Xinjiang Uygur Autonomous Region, China between March 2016 and December 2021. Small intestinal biopsy and serum-specific antibodies were used to diagnose CD. RESULTS Of the 102 CD patients, 63.7% were women (female: male = 1.76:1), and the mean age was 47.3 ± 14.7 years at diagnosis. Common gastrointestinal symptoms included abdominal pain (50.0%), diarrhea (39.2%), and abdominal distension (24.5%). While common extraintestinal manifestations were anemia (48.0%), osteopenia or osteoporosis (36.3%), and fatigue (35.3%). Approximately 34.3% of patients with CD had comorbidities, with the most common being thyroid diseases (18.6%). Biochemical profiles showed lower hemoglobin, higher platelet count, and 25-hydroxyvitamin D (25[OH]D) deficiency. HLA-DQ2/DQ8 was detected among all 53 patients who underwent genotype testing; the frequency of the HLA-DQ2.5, DQ2.2, and DQ8 haplotypes was 71.7%, 24.5%, and 3.8%, respectively. CONCLUSIONS CD was more common among women. Clinical manifestations include primarily gastrointestinal symptoms, but extraintestinal manifestations were not uncommon. Lower hemoglobin level, higher platelet count, and 25[OH]D deficiency are the main biochemical manifestations. The HLA-DQ2.5 and DQ2.2 haplotypes are the most common genotypes in CD.
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Affiliation(s)
- Tian Shi
- Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yan Feng
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Zi Qiong Li
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jia Jie Lu
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Adilai Abudurexiti
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Ayinuer Maimaitireyimu
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jia Li Hu
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Man Wang
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hong Bo Zhou
- Department of Gastroenterology, Nanjing Medical University Affiliated Kizilsu People's Hospital, Kizilsu Kergez Autonomous Prefecture, Xinjiang Uygur Autonomous Region, China
| | - Aini Abudureyimu
- Department of Gastroenterology, Kashgar Second People's Hospital, Kashgar, Xinjiang Uygur Autonomous Region, China
| | - Xin Mei
- Department of Gastroenterology, Altay Regional People's Hospital, Altay, Xinjiang Uygur Autonomous Region, China
| | - Xin Wen Guo
- Department of Gastroenterology, Aksu People's Hospital, Aksu, Xinjiang Uygur Autonomous Region, China
| | - Wei Dong Liu
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Feng Gao
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.,Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang Uygur Autonomous Region, China
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Dehghani SM, Ilkhanipour H, Samipour L, Niknam R, Shahramian I, Parooie F, Salarzaei M, Tahani M. Investigation of the Factors Affecting Bone Mineral Density in Children with Celiac Disease. Pediatr Gastroenterol Hepatol Nutr 2022; 25:138-146. [PMID: 35360377 PMCID: PMC8958055 DOI: 10.5223/pghn.2022.25.2.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/09/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Children with celiac disease (CD) are at an increased risk of low bone mineral density (BMD) owing to malabsorption of fat-soluble vitamins, inflammation, and malnutrition. This study aimed to determine the prevalence and risk factors for low BMD in Iranian children with CD. METHODS This prospective cohort study examined 149 Iranian children with CD between 2011 and 2018 at Zabol University of Medical Sciences. BMD was measured using dual-energy X-ray absorptiometry. Demographic, clinical, and laboratory data were collected from patients' medical records. Logistic regression analysis was performed to identify the factors associated with low areal BMD (BMD-Z <-2) in the lumbar spine and femoral neck. Descriptive data were analyzed using the mean, standard deviation, and relative frequency. Data were analyzed using the chi-square test, t-test, and analysis of variance. RESULTS Of the 149 children with CD, 27.5% had osteoporosis. The mean body mass index (BMI) Z score was -1.28±1.2. Lower BMI was associated with a higher likelihood of BMD-Z (odds ratio 2.17; p≤0.05). CONCLUSION Overall, the findings of this study showed that there was no correlation among Marsh classification, presence of specific human leukocyte antigens, and low BMD in Iranian children with CD. BMI can be a predictor of bone density in children with CD and may be applied clinically in early screenings to evaluate the bone health status in these children.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Shiraz Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Homa Ilkhanipour
- Department of Pediatric, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Samipour
- Department of Pediatric, Shiraz University of Medical Science, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Iraj Shahramian
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Fateme Parooie
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Morteza Salarzaei
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Masoud Tahani
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
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