Analysis of Body Composition and Food Habits of Spanish Celiac Women

Global Approach to Follow-Up of Celiac Disease

Celiac disease, an autoimmune disorder induced by the ingestion of gluten, affects approximately 1.4% of the population. Gluten damages the villi of the small intestine, producing symptoms such as abdominal pain, bloating and a subsequent loss of nutrient absorption, causing destabilization of the nutritional status. Moreover, gluten can trigger extra intestinal symptoms, such as asthma or dermatitis, but also mental disorders such as depression or anxiety. Moreover, people suffering from celiac disease sometimes feel misunderstood by society, mainly due to the lack of knowledge about the disease and the gluten-free diet. Thus, the treatment and follow-up of patients with celiac disease should be approached from different perspectives, such as the following: (1) a clinical perspective: symptomatology and dietary adherence monitorization; (2) nutritional assessment: dietary balance achievement; (3) psychological assistance: mental disorders avoidance; and (4) social inclusion: educating society about celiac disease in order to avoid isolation of those with celiac disease. The aim of this narrative review is to gain deep insight into the different strategies that currently exist in order to work on each of these perspectives and to clarify how the complete approach of celiac disease follow-up should be undertaken so that the optimum quality of life of this collective is reached.

Study Protocol for a Controlled Trial of Nutrition Education Intervention about Celiac Disease in Primary School: ZELIAKIDE Project

The only treatment for celiac disease (CD) is a strict and lifelong gluten-free diet (GFD), which must be safe and nutritionally balanced. Avoiding gluten brings difficulties with following the diet and can affect the social life of people with CD. The Zeliakide Project is a nutrition education program aimed at increasing the knowledge of the general population about healthy diets, CD and GFD, and, therefore, to improve the social inclusion and quality of life of people with CD. It is a one-month intervention program, two-armed cluster, non-randomised and controlled trial, conducted among 10-12-year-old children. Pre- and post-intervention evaluation and 1 month follow-up will be carried out to assess the effectiveness of the program. It is based on competencies and their respective learning outcomes. The teaching methodology chosen is a STEAM methodology: inquiry-based learning (IBL). A teaching unit has been created to develop the project, which, in the future, will be useful for the self-application of the program. This study will provide a valid and useful tool to achieve changes in the diet at the school level and will help to promote the social inclusion of people with CD. Moreover, it will enforce the STEAM competences of children.

The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.

Nutritional Status and Metabolism in Celiac Disease: Narrative Review

This review summarizes findings from studies assessing the nutritional status of patients with celiac disease (CD). Malnutrition, including over- and undernutrition, may be present in CD, both at diagnosis and while under treatment. Underweight and growth retardation in children, which mostly reflect malabsorption as a consequence of intestinal inflammation, are not a rule. Clinical presentations of CD can vary widely, and each manifestation has its own characteristics. Evaluating various nutritional parameters can be beneficial for CD patients and may improve health outcomes by facilitating an accurate definition of dietary needs and the development of a balanced diet that not only focuses on eliminating gluten but also provides adequate nutrients, alters metabolism, and reduces the risk of other disorders developing. The cornerstone of CD therapy is a gluten-free diet (GFD), which improves nutritional status, but even on a GFD, features of malnutrition may be present. Additionally, overweight and obesity may occur in patients on a GFD, with typical metabolic consequences.

Diet quality, ultra-processed food consumption, and quality of life in a cross-sectional cohort of adults and teens with celiac disease

BACKGROUND

Coeliac disease (CeD), a common autoimmune condition, requires strict adherence to a gluten-free diet (GFD). Adherence to the GFD has been associated with quality of life (QOL). However, there may be other diet-related concerns, such as overall diet patterns, including diet quality or ultra-processed food (UPF) consumption, possibly associated with QOL among people with CeD following a GFD that have not been examined.

METHODS

Diet quality was determined based on 24-h diet recalls of a cross-sectional prospectively recruited sample of 80 participants (50 adults and 30 teens) with biopsy-confirmed CeD ('Study Sample') using the Healthy Eating Index and Alternate Mediterranean Diet score. The amount of UPF consumed was assessed using Nova, a food processing classification system. QOL was measured using Celiac Disease-Specific Quality of Life (CDQOL) and Celiac Disease Pediatric-Specific Quality of Life (CDPQOL). The Study Sample's diet patterns were compared with National Health and Nutrition Examination Survey (NHANES) groups (25 adults reporting prior CeD and GFD; 51 adults with new CeD and no GFD; 15,777 adults and 2296 teens without CeD). The relationship of the Study Sample's diet patterns with CDQOL/CDPQOL was assessed using analysis of covariance.

RESULTS

The Study Sample's diet patterns were suboptimal but generally favourable compared with all NHANES groups. Compared to Study Adults with the highest tertile of UPF, those with the lowest tertile had significantly higher CDQOL (mean: 67.6 vs. 78.3, p < 0.001). Compared to Study Teens with the lowest tertile of AMED, those with the highest tertile had significantly higher CDPQOL (mean: 67.0 vs. 79.9, p < 0.01).

CONCLUSIONS

Maintaining high diet quality and minimising UPF may be important for CeD-specific QOL among individuals with CeD maintaining a GFD.

Assessment of Nutritional Status by Bioelectrical Impedance in Adult Patients with Celiac Disease: A Prospective Single-Center Study

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.

EATING HABITS AND NUTRITIONAL STATUS OF PATIENTS WITH CELIAC DISEASE IN SOUTH BRAZIL

•Most patients with celiac disease from South Brazil do not consume gluten. •Patients with celiac disease are more careful about gluten cross-contamination in their homes than in restaurants. •Patients with celiac disease from South Brazil have adopted good eating habits with a balanced gluten-free diet. •Nutritional status improved after diagnosis of celiac disease according to body mass index. Background - Celiac disease is defined as a chronic autoimmune disease that affects the small intestine in genetically predisposed people, triggered by exposure to gluten. The only treatment for celiac disease to date is a lifelong gluten-free diet. Eating habits of celiacs play an important role in their nutritional status.Objective - To evaluate the eating habits and nutritional status of patients with celiac disease in Rio Grande do Sul.Methods - This is a cross-sectional study with patients diagnosed with celiac disease residing in Rio Grande do Sul (Brazil) over 18 years of age. An online questionnaire was applied with calls through social networks and also by the Associação dos Celíacos do Brasil - Rio Grande do Sul Section. Sociodemographic data, history of celiac disease, general medical history, reported weight and height and food consumption data (SISVAN food frequency questionnaire and general questions) were collected. Results - The sample consisted of 142 individuals with a mean age of 39.75±11.5 years, 94.4% were women and 93% were white. The patients showed care regarding a gluten-free diet, with the majority not ingesting gluten (82.2%) and being careful regarding cross-contamination by gluten in their homes (85.9%) and in restaurants (62, 4%). Most patients also had good eating habits, with frequent consumption of fruits, vegetables, meats, eggs and low frequency of processed foods and fats. Body weight before and after the diagnosis of celiac disease did not show significant changes (62.3±13.8 versus 63.6±11.7 kg; P=0.147); however, there was an improvement in the classification of nutritional status by body mass index (malnourished: 11.6% before versus 2.3% after; P=0.016). Conclusion - Most celiac disease patients in this study have good eating habits with a balanced gluten-free diet and improved nutritional status after diagnosis according to body mass index classification.

Gluten-Free Diet and Metabolic Syndrome: Could Be a Not Benevolent Encounter?

Celiac disease is a rising disorder and is becoming frequently diagnosed in recent years. To date, the only available treatment is the gluten-free diet (GFD). The role of gluten on components of metabolic syndrome and on related inflammatory response is still unclear due to controversial results. In recent years, scientific focus on this topic has been growing up, in particular regarding the role of the GFD on glycometabolic parameters and diabetes. In addition, studies on the remaining components showed discordant results, which was likely due to heterogeneous and large celiac disease populations and to the lack of prospective studies. Furthermore, knowledge about the role of the GFD on inflammatory cytokines and the relationship among vitamin D and celiac disease, metabolic syndrome (MS) and GFD is needed. In this narrative review, we provided evidence regarding the role of the GFD on glycometabolic parameters, cholesterol, triglycerides, waist circumference, blood pressure and inflammatory cascade, also evaluating the role of vitamin D, trying to summarize whether this nutritional pattern may be a value-added for subjects with dysmetabolic conditions. Finally, due to the limited findings and very low-certainty evidence, predominantly based on observational studies, the real effects of a GFD on different components of MS, however, are unclear; nevertheless, an improvement in HDL levels has been reported, although data on glycemic levels are discordant.

Gluten-Free Products: Do We Need to Update Our Knowledge?

The gluten-free (GF) food market has been growing exponentially in recent years. However, GF products could contribute to imbalanced diets. The main objective of the present work was to perform a temporal nutritional comparison of GF foods over the last nine years. At the same time, the nutritional compositions of 104 GF products currently marketed in Spain were assessed and compared with their gluten-containing counterparts. Diets including GF products and the equivalent diets with homologous products with gluten were compared as well, the subjects being 25 adult celiac patients. A comparison of GF products (GFPs) in 2013 and 2022 showed nutritional differences in the groups of cookies, breakfast cereals, doughs/puff pastries/pizzas, and breads. The pasta group stands out from the rest due to an important decrease in energy, protein, simple carbohydrates, saturated lipids, dietary fiber, and salt. Comparing GF and gluten-containing homologous products in 2022, the major differences were found in protein and salt. Accordingly, GFPs lead to a diet lower in protein and higher in carbohydrates. Despite improvements in the formulation of GF products in recent years, their macronutrient profile maintains marked variation, and they cannot be considered nutritionally equivalent to their gluten-containing counterparts.

Psychological, Physiological, and Physical Effects of Resistance Training and Personalized Diet in Celiac Women

Background

Gluten intolerance is a systemic process of autoimmune nature; it develops in genetically predisposed subjects with gluten ingestion. The only treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). This study was designed to evaluate adherence to a GFD, risk of an eating disorder, and nutritional status in adult CD patients undergoing different interventions.

Methods

A total of 28 Spanish women, aged 40 years or more, took part in a randomized controlled trial. Each group received a different intervention: group 1, gluten-free nutrition plan + exercise (GFD + E); group 2, gluten-free nutrition plan (GFD); group 3, celiac controls (NO-GFD); and group 4, non-celiac controls (CONTROL). The training was prescribed by a sport scientist. It was based on resistance training with elastic bands; beforehand a warm-up was performed and the resistance was increased progressively. The variables studied were adherence to the GFD, risk of eating disorders, blood values, and body composition.

Results

Celiac women with personalized nutritional planning presented greater adherence to a gluten-free diet (p < 0.001). Regarding leukocytes, significant differences were observed between the GFD and control groups (p = 0.004). Perimeters and folds did not decrease significantly.

Conclusion

Women with celiac disease who follow an adapted and personalized diet have a better adherence to a GFD compared to those who follow a non-professional diet, and therefore have a better immune system status (blood leukocytes).

Long-Term Effect of Gluten-Free Diets on Nutritional Status, Body Composition, and Associated Factors in Adult Saudi Females with Celiac Disease

This cross-sectional study examines the influence of long-term gluten-free diet (GFD) consumption on nutritional status, body composition, and associated factors in adult Saudi females with celiac diseases (CD). Fifty-one patients who have been diagnosed with CD and have been on GFD for more than 1 year were included in this study where data regarding their dietary pattern, as well as a complete analysis of their anthropometric parameters, vitamins B12 and D levels, and complete blood count (CBC), were collected. Data have shown that all included patients showed a reduced intake in all micro and macro-nutrients, as well as vitamin D, folate, calcium, and iron. However, the vast majority of all measured hematological parameters and blood indices were within the expected reference range. In addition, 51%, 43.1%, and 60.8% of the patients showed low waist/hip ratio (WHR), decreased level of total body fat (BF), and decreased level of visceral fat (VF), respectively, whereas 33.3% were slim. The poor educational level and some psychosocial factors were associated with the poor nutritional status of the patients. In conclusion, the GFD-dependent intake by female patients with CD adversely affects their nutritional intake and anthropometric indices and leads to a deficiency in major nutrients, vitamins, and ions.

Application of a Platform for Gluten-Free Diet Evaluation and Dietary Advice: From Theory to Practice

The present work aimed to analyze, through the GlutenFreeDiet digital platform, the evolution over one year of the nutritional status, dietary profile and symptoms present among celiac people on a gluten-free diet (GFD) while receiving individualized dietary advice. Twenty-seven adults and thirty-one celiac children/adolescents participated in the study. This was then followed up by three visits, at diagnosis, and after 3 and 12 months (vt0, vt3 and vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires. All patients received written personalized dietary advice from dietitians who interpreted data from the platform. Results obtained indicated that participants consumed proteins and lipids in excess and carbohydrates in defect. Low intakes of cereals, fruit and vegetables and high meat intakes were observed. However, gluten-free product (GFP) consumption and that of ultra-processed foods was reduced after 1 year in adults. Symptoms decreased after vt3 but recurred in vt12. Changes in ultra-processed foods and GFP intake, but lack of changes in the rest of the parameters suggested that the platform support was not effective enough. Even though the platform represents a useful tool for monitoring celiac patients and giving dietary advice, modules that require more continuous attention and nutritional education of patients should be provided for interventions to be more effective.

Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet

Celiac disease (CD) is a chronic autoimmune disorder of the small intestine, whose only effective treatment is a gluten-free diet (GFD). It is characterized by the atrophy of the intestinal villi that leads to altered nutrient absorption. This study describes the nutritional imbalances which may be found in adults with CD following a GFD. During the first year of treatment, deficiencies will overcome as the intestinal mucosa recovers. Thus, biochemical data will show this progression, together with the decrease in symptoms. In contrast, in the long term, when a strict GFD is followed and mucosal recovery is achieved, analyzing nutrient intake makes more sense. Macronutrient consumption is characterized by its low complex carbohydrate and fiber intakes, and high fat (especially SFA) and sugar intakes. This profile has been related to the consumption of GFP and their nutritional composition, in addition to unbalanced dietary habits. The most notable deficiencies in micronutrients are usually those of iron, calcium and magnesium and vitamin D, E and some of group B. It is necessary to follow up patients with CD and to promote nutritional education among them, since it could help not only to achieve a gluten free but also a balanced diet.

Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac

The only available treatment for celiac disease is life-long gluten exclusion. We conducted a cross-sectional age- and gender-matched study in 64 celiac adults on a long-term (>1 year) gluten-free diet and 74 non-celiac volunteers from Spain, using dietary, anthropometric, and biochemical parameters, as well as assessing bone mineral density and physical activity. Celiac adults had deficient intake (below 2/3 of the recommended intake) for folates, vitamin E, and iodine and low intake of calcium (below 80% of the recommended intake). Iron intake was also below 2/3 of the recommended intake in celiac women. Vitamin D intake was extremely low, and 34% of celiac patients had moderately deficient plasma levels. According to bone mineral density, celiac women may be more prone to osteopenia and osteoporosis. However, we found a perfectly analogous nutritional status scenario in celiac as compared to healthy volunteers, with the dietary deviations found being similar to those of the Spanish population, i.e., both groups followed a high-lipid, high-protein, and low-carbohydrate diet. Values for biochemical parameters were found within the reference ranges. Celiac disease had no influence on body weight, but body fat in celiac patients tended to be higher. According to our results, vitamin D, calcium, folates, vitamin E, iodine, and iron nutritional status should be specifically assessed and monitored in the celiac population.

Comparison of diet quality between celiac patients and non-celiac people in East Azerbaijan-Iran

Background

Considering the lifelong dietary restriction in celiac patients, it is important to assess the diet quality in these patients. Hence, this study aimed to investigate the diet quality in adult celiac patients and compare it with that of the non-celiac people.

Methods

In the present cross-sectional study, 130 celiac patients were selected from the celiac disease (CD) registry database of East Azerbaijan province, Iran. Non-celiac people (n = 464) was selected from the major lifestyle promotion project conducted in the East Azerbaijan district. The dietary intake data was obtained by an 80-item semi-quantitative food frequency questionnaire. Diet quality was assessed using the healthy eating index-2015 (HEI-2015).

Results

The mean total HEI score was significantly higher in the celiac group compared with the non-celiac people (P < 0.001) and 68.5% of non-celiac people and 17.4% of celiac patients had poor diet quality. After adjusting for confounding factors, the mean score of total HEI in adherents to gluten-free diet (GFD) was significantly higher compared with non-adherents (P = 0.007).

Conclusions

Although the mean total HEI score was higher in celiac patients compared with the non-celiac people, about 17.5% of patients had poor diet quality and the scores of whole grains and dairy products group were very low in our population. Accordingly, it seems that educational programs should be held for the celiac patients and non-celiac people to increase their nutritional literacy and enable them to select healthy gluten-free alternatives.

Excess weight and gastrointestinal symptoms in Chilean celiac patients at the time of diagnosis

INTRODUCTION

celiac disease is an immune condition that results in histologic changes in the small bowel and produces both digestive and extra-digestive symptoms. Intestinal damage results in malabsorption and impaired weight or impaired optimal weight gain. However, these patients may be overweight or obese in spite of histologic damage. The aim of this study was to determine the prevalence of excess weight in newly diagnosed (adult) celiac patients.

METHODS

this was a retrospective observational study of patients recently diagnosed with celiac disease according to the standard Marsh classification. Nutritional status was assessed based on body mass index (BMI), as categorized by the World Health Organization (WHO). Clinical presentation was classified as typical or atypical. Potential differences in gastrointestinal symptoms according to nutritional status were also assessed.

RESULTS

a total of 135 medical records of adult celiac patients (women = 123; men = 12) were reviewed. The average weight and BMI were 61.1 kg and 23.7 kg/m2, respectively. The proportion of typical clinical presentations was 59.2% and of atypical presentations 40.8%. A total of 71.8% of patients had a BMI indicating low or normal weight and 28.1% had a BMI indicative of being overweight or obese. No differences with regard to the presence of gastrointestinal symptoms were found according to nutritional status.

CONCLUSIONS

further studies are needed to jointly assess energy intake and intestinal absorption in these patients, in order to explain the high rate of excess weight.

Tools Used to Measure the Physical State of Women with Celiac Disease: A Review with a Systematic Approach

Celiac disease (CD) is an immunological disorder that mainly affects the small intestine, generating an inflammatory process in response to the presence of gluten (a protein). Autoimmune diseases are part of a group of diseases that are difficult to diagnose without a specific protocol or consensus to detect them due to the number of symptoms and diseases with which it has a relationship. Therefore, the aim of this review was to analyze the diagnostic tools of CD used in middle-aged women, to compare the use and effectiveness of the different tools, and to propose a strategy for the use of the tools based on the results found in the literature. The present research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search was conducted in the following databases: Scielo, PubMed, Web of Science, and Worldwide Science org. In the initial literature search, 2004 titles and relevant abstracts were found. Among them, 687 were duplicates, leaving 1130 articles. Based on the inclusion criteria, only 41 articles passed the selection process; 4 main types of analyses appear in the studies: blood tests, questionnaires, clinical history, and biopsy. It can be said that none of the analyses have a 100% reliability since most of them can present false negatives; therefore, the best way to diagnose celiac disease up to now is through a combination of different tests (Immunoglobulin A and small intestinal biopsy).

New Software for Gluten-Free Diet Evaluation and Nutritional Education

Following a gluten-free diet (GFD) is the only treatment for celiac disease. This diet must ensure the absence of gluten but also needs to be nutritionally balanced. Dietitians working in this field cannot properly evaluate energy and nutrient intake of celiac people because dietary programs available on the market do not contain the nutritional composition of gluten-free products (GFP). Here we present a new GFD evaluation software that contains more than 700 gluten-free rendered foodstuffs and their macronutrient composition. Apart from diet evaluation and design, the software represents a tool for nutritional education as well, since it shows diet appropriacy and indicates how to promote balanced self-care. Moreover, anthropometric and biochemical data or symptoms presence and diet adherence can be recorded and evaluated. This open free software, can be downloaded in its app format for mobiles and tablets. Software evaluation indicated its correct functionality and the importance of assessing a GFD with GFP instead of with their gluten-containing analogues. Thus, this software represents an essential e-Health tool, not only for proper GFD evaluation, but also for improving life quality of celiac and gluten sensitive people.

Anthropometric Parameters in Celiac Disease: A Review on the Different Evaluation Methods and Disease Effects

This review compiled anthropometric data from 29 original articles, published between 1995 and 2015, corresponding to a total sample of 6368 celiac disease subjects. Body mass index was the main parameter for measuring anthropometry (82.1%), followed by body mass (78.6%), body fat (51.7%), bone mineral density and bone mineral content (46.4%), and fat-free mass (44.8%). The main evaluation method was dual x-ray absorptiometry (83.3%), followed by bioimpedance (16.6%), skinfold thickness (16.6%), and isotope dilution (5.5%). This compilation suggests that celiac disease patients without a gluten-free diet (WGFD) and celiac disease patients with a gluten-free diet (GFD) show a lower body mass than the control group, with inconclusive data about WGFD versus GFD. Body mass index is lower in WGFD and GFD compared to control group, and is lower in WGFD compared to GFD. We observed lower values of FM and FFM in WGFD and GFD versus the control group. No difference was found between WGFD versus GFD. BMD and BMC are lower in WGFD versus GFD and GFD versus the control group, with inconclusive data about WGFD versus GFD. The findings of this review suggest that celiac disease patients must be periodically evaluated through anthropometric parameters, since the pathology has the potential to modulate such values even in a gluten-free diet, with these variables reflecting their healthy status. In parallel, the screening of different anthropometric assessment methodologies can provide support for more accurate evaluations by scientists and clinical professionals who work with celiac disease patients.

Celiac Male's Gluten-Free Diet Profile: Comparison to that of the Control Population and Celiac Women

The aim of the present work was to analyze the body composition and dietary profile of Spanish celiac men and to compare them to control men and celiac women from our previous studies. Forty-two celiac men (31.5 ± 11.9 years) were recruited and anthropometric measurements were taken. Analysis of energy consumption, macro- and micronutrient intake and food frequency consumption was carried out. Celiac men were more overweight and obese than celiac women, but less than the control population, reporting the same energy intake and macronutrient distribution. Most micronutrient deficiencies in celiac men were not directly related to a gluten free diet; these were also observed for the entire population. The least adherence to Dietary Reference Intakes in women was reported for iron, iodine, potassium and selenium, whereas magnesium intake was higher than in men. Among celiac participants (both genders), cereal, vegetable and legume consumption was poor and meat intake was contrastingly excessive. In conclusion, the dietary profile of celiac men is as unbalanced as that of control men but slightly more than that of celiac women. General nutritional education should be given to both general and celiac populations, and specific advices to celiac men, in order to decrease the risk of celiac disease-related pathologies.

Impact of type 1 diabetes mellitus and celiac disease on nutrition and quality of life

Objective:

Type 1 diabetes mellitus (T1DM) and celiac disease (CD) are autoimmune diseases and have similar genetic patterns. T1DM treatment is based on diet, physical activity and insulin therapy, whereas CD depends on dietary changes with restriction of wheat, rye and barley. The aim of the study was to evaluate the quality of life (QoL) of individuals with the association of T1DM and CD, to characterize their nutritional status and to compare it with those with only one disease and healthier controls.

Subjects/Methods:

Sixty patients controlled by sex, age and body mass index (BMI) were stratified by previous diagnosis in: T1DM and CD (DMCD group); T1DM (DM group); CD (CD group); or healthy participants (HC). The SF-36 questionnaire was applied to assess psychological well being and results were compared with glycemic control and presence of complications related to diabetes, adhesion to gluten-free diet (GFD). Nutritional status and body mass composition were determined by BMI, waist circumference, bioimpedance, general laboratory tests and whole-body densitometry.

Results:

The time of diagnosis of T1DM was similar between DMCD and DM groups; however, the duration of CD was significantly higher in the CD group compared with DMCD. The SF-36 analysis revealed statistically significant differences between DM and HC groups in two domains: general health (P=0.042) and energy/vitality (P=0.012). QoL was also correlated with compliance to a GFD, and scores were similar in both groups: DMCD and CD. Forty percent of individuals in the CD group had visceral fat area above 100 cm², as opposed to 20% in the other groups.

Conclusions:

Individuals of DMCD group had similar scores to DM, CD and HC on QoL, as well as on their nutritional status and bone metabolism. Thereby, we should conclude that the association of T1DM and CD did not deteriorate their health status.