1
|
Mudryj AN, Waugh AK, Slater JJ, Duerksen DR, Bernstein CN, Riediger ND. Nutritional implications of dietary gluten avoidance among Canadians: results from the 2015 Canadian Community Health Survey. Br J Nutr 2021; 126:738-46. [PMID: 33172514 DOI: 10.1017/S000711452000450X] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adherence to a gluten-free diet (GFD) is the only available treatment for gluten-related disorders, although a GFD may also be followed for discretionary reasons. The main objectives of the present study were to (1) describe and test for differences in key nutrient intakes among Canadians who follow a GFD compared with Canadians with no dietary exclusions and (2) describe additional dietary avoidances adhered to by Canadians who avoid gluten. We conducted a secondary analysis of the cross-sectional 2015 Canadian Community Health Survey-Nutrition Survey, which included a general health survey and 24-h dietary recall (n 20 487). Participants were categorised as those who avoid dietary gluten and those who reported no avoidances. Key nutrient intakes were assessed, as a percentage of Dietary Recommended Intakes, including fibre, B vitamins, vitamin D, Ca, Fe, Na and Zn, and compared between the two groups using t tests. Canadians who avoided gluten had significantly lower intakes of folate, vitamin B12, vitamin D, Fe, Na and Ca compared with those who did not avoid any food groups. However, Canadians who reported following a GFD were significantly more likely to use vitamin or mineral supplements in the past 30 d. More than 20 % of those who avoided gluten also avoided dairy products. Findings suggest that following a GFD places Canadians at risk for nutrient inadequacies, particularly folate, Ca and vitamin D. Further research is required to further examine how multiple dietary avoidances among those who avoid gluten may contribute to dietary inadequacies.
Collapse
|
2
|
Ren Y, Linter BR, Linforth R, Foster TJ. A comprehensive investigation of gluten free bread dough rheology, proving and baking performance and bread qualities by response surface design and principal component analysis. Food Funct 2021; 11:5333-5345. [PMID: 32459258 DOI: 10.1039/d0fo00115e] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Contribution of methylcellulose (MC), psyllium seed husk powder (PSY), and water addition level to gluten free bread quality and correlations between dough rheological properties and bread qualities were investigated by response surface design and principal component analysis. The generalised Maxwell model was applied to estimate the relaxation frequency of gluten free doughs. The addition of PSY has a complex influence on pasting viscosity at high temperature and an additional peak was observed. MC significantly influenced dough extensibility and work of adhesion, which are good predictors of bread volume and textural properties. Other rheological responses are less significantly correlated to specific volume, but they are sensitive to formulation variations, reflect dough structures and stability, related to proving behaviours, and correlated to loaf concavity. An inappropriate combination of water and hydrocolloids might lead to problems such as low stability of doughs, overexpansion, and weak crumb structure at high water addition levels, or, in contrast, high rigidity of dough, a trap of excessive air during mixing, and restrained gas cell expansion with high hydrocolloid addition and low water addition.
Collapse
Affiliation(s)
- Yi Ren
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK.
| | - Bruce R Linter
- PepsiCo International Ltd, 4 Leycroft Rd, Leicester, LE4 1ET, UK.
| | - Robert Linforth
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK.
| | - Tim J Foster
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK.
| |
Collapse
|
3
|
Chaudhuri A, Goddard EA, Green M, Ardura MI. Diarrhea in the pediatric solid organ transplantation recipient: A multidisciplinary approach to diagnosis and management. Pediatr Transplant 2021; 25:e13886. [PMID: 33142366 DOI: 10.1111/petr.13886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/25/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
Diarrhea in the pediatric solid organ transplantation (SOT) recipient is a frequent complaint that is associated with significant morbidity and impaired quality of life. There are limited published data regarding the specific epidemiology, diagnostic evaluation, and treatment of diarrhea after SOT in children. Pediatric SOT recipients have an increased risk of developing diarrhea because of a generalized immunosuppressed state, epidemiologic exposures, and polypharmacy. There is a need to standardize the diagnostic evaluation of diarrhea in children after SOT to facilitate an accurate diagnosis and timely treatment. Herein, we review the available published data and propose a systematic, stepwise approach to the evaluation of diarrhea in this high-risk population, focusing on timely diagnosis of both infectious and non-infectious causes, in order to provide focused management. Prospective studies are needed to better assess the true prevalence, risk factors for, etiologies, and complications of diarrhea in pediatric SOT patients that will guide optimal management. Development of effective vaccines and antiviral therapies for enteric viruses may also contribute to improved outcomes.
Collapse
Affiliation(s)
- Abanti Chaudhuri
- Department of Pediatrics, Division of Nephrology, Stanford University, Stanford, CA, USA
| | - Elizabeth Anne Goddard
- Department of Pediatrics, Division of Pediatric Gastroenterology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Michael Green
- Department of Pediatrics, Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases & Host Defense Program, Nationwide Children's Hospital & The Ohio State University, Columbus, OH, USA
| |
Collapse
|
4
|
|
5
|
Puñales M, Bastos MD, Ramos ARL, Pinto RB, Ott EA, Provenzi V, Geremia C, Soledade MA, Schonardie AP, da Silveira TR, Tschiedel B. Prevalence of celiac disease in a large cohort of young patients with type 1 diabetes. Pediatr Diabetes 2019; 20:414-420. [PMID: 30737863 DOI: 10.1111/pedi.12827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/01/2018] [Accepted: 01/27/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin-A anti-tissue transglutaminase antibodies (IgA-tTG) and CD in a large cohort of young T1DM patients. METHODS Screening for CD was randomly conducted in 881 T1DM by IgA-tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy. RESULTS The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA-tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7-131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CD patients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0-9.9 years). The modified Marsh-Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy-proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA-tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative-biopsies. CONCLUSION Our results demonstrate the prevalence of 7.7% of IgA-tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high-risk individuals. Furthermore, the presence of GI manifestations and higher IgA-tTG titers strongly suggest the diagnosis of CD.
Collapse
Affiliation(s)
- Marcia Puñales
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil.,Pediatric Endocrinology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Marilia Dornelles Bastos
- Post-Graduation Program in Adolescent and Child Health, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Medical Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Ana Regina L Ramos
- Pediatric Gastroenterology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Raquel Borges Pinto
- Pediatric Gastroenterology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Eduardo A Ott
- Endoscopy Service, Nossa Senhora da Conceição Hospital (HNSC), Conceição Hospital Group (GHC), Porto Alegre, RS, Brazil
| | - Valentina Provenzi
- Pathology Service, Nossa Senhora da Conceição Hospital (HNSC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - César Geremia
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil.,Pediatric Endocrinology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Maria Antônia Soledade
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Ana Paula Schonardie
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Themis R da Silveira
- Post-Graduation Program in Adolescent and Child Health, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Santo Antônio Child Hospital, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Balduino Tschiedel
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| |
Collapse
|
6
|
Paruk IM, Naidoo VG, Pirie FJ, Maharaj S, Nkwanyana NM, Dinnematin HL, Ganie Y, Ramdial PK, Motala AA. Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study. J Gastroenterol Hepatol 2019; 34:673-678. [PMID: 30600564 DOI: 10.1111/jgh.14596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/20/2018] [Accepted: 12/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa. METHODS This was a cross-sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), and anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification. RESULTS Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively. CONCLUSION The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus.
Collapse
Affiliation(s)
- Imran M Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Vasudevan G Naidoo
- Department of Gastroenterology and Hepatology, University of KwaZulu-Natal, Durban, South Africa
| | - Fraser J Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Sureka Maharaj
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | | | - Hilary L Dinnematin
- Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Yasmeen Ganie
- Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Pratistadevi K Ramdial
- Department of Anatomical Pathology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
7
|
Shahraki T, Shahraki M, Hill ID. Frequency of overweight/obesity among a group of children with celiac disease in Iran. Prz Gastroenterol 2018; 13:127-31. [PMID: 30002771 DOI: 10.5114/pg.2018.73347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
Introduction A small number of overweight and obese children with celiac disease (CD) has been reported. Aim To estimate the prevalence of obesity, underweight and normal weight in a group of Iranian pediatric patients. Material and methods In a retrospective study from 2007 to 2015, 225 children less than 18 years old with biopsy-proven CD were enrolled. Data collected included demographic characteristics, clinical presentation, antibody titers and severity of small-bowel mucosal damage. Body mass index (BMI) profile of subjects was calculated based on the age and gender percentile at presentation. Results The mean ± standard deviation (SD) for age was 7.4 ±3.8 and 62% of patients were female. Fifty-four percent of patients presented with a normal BMI, 43% were underweight, and the remaining patients (3.5%) were overweight/obese. The mean age of underweight and normal weight patients was higher than that of obese/overweight patients. Mean ± SD of TTG titer was higher in overweight/obese and normal weight children compared to underweight subjects. The majority of patients (195/225) had severe enteropathy compatible with Marsh III on duodenal biopsy. Most of the children had gastrointestinal (GI) and extra-intestinal manifestations on presentation. There was no association between severity of histological disease and BMI for age. Five out of eight cases in the obese/overweight group had an index case with CD in their family. Conclusions This study highlights the importance of considering celiac disease in children regardless of their BMI. Failure to diagnose CD in children leads to unnecessary diagnostic delays and long-term adverse health consequences.
Collapse
|
8
|
De Silvestri A, Capittini C, Poddighe D, Valsecchi C, Marseglia G, Tagliacarne SC, Scotti V, Rebuffi C, Pasi A, Martinetti M, Tinelli C. HLA-DQ genetics in children with celiac disease: a meta-analysis suggesting a two-step genetic screening procedure starting with HLA-DQ β chains. Pediatr Res 2018; 83:564-72. [PMID: 29244800 DOI: 10.1038/pr.2017.307] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/18/2017] [Indexed: 02/07/2023]
Abstract
BackgroundSpecific HLA-DQ genes have been recognized as necessary - but not sufficient - factors for the occurrence of Celiac Disease (CD). Through a meta-analysis, evaluating the distribution of CD-related HLA genotypes in children, we aimed at providing insights for a potential widened screening strategy.MethodsAfter a systematic search on the association between class II HLA genes and CD in children, 46 publications were obtained and assessed for eligibility. A total of 13 eligible studies were submitted to data extraction and analysis (10 case-control studies and 3 cohort studies). Case-control studies collectively enrolled 740 CD patients and 943 controls.ResultsIn the population-stratified analysis, the following alleles conferred a significantly increased risk for CD: HLA-DQB1*02 (odds ratio [OR]=10.28) and HLA-DQB1*03:02 (OR=2.24). By drafting a risk gradient to develop CD according to HLA genetic background, the highest risk is confirmed to exist for DQ2/DQ2 homozygous subjects, regardless of the ethnicities (OR=5.4). Actually, the genotype DQ2/β2 showed basically the same risk (OR=5.3). Indeed, no differences have been found in CD risk between DQ2/β2 and DQ2/DQ2, as well as between DQ8/β2 and DQ2/DQ8, and between β2/DQX and DQ2/X.ConclusionThe HLA-DQB1*02:01 allele is present in more than 90% CD children. In the perspective of a widened pediatric population screening for CD, a double-step process might be suggested: HLA-DQB1*02:01 might be investigated first and, only if this result is positive, children might be candidate for a prospective serologic screening, as a second step.
Collapse
|
9
|
Dos Santos Domingues A, Selleski N, Uenishi RH, Medeiros Ribeiro de Magalhães C, Gandolfi L, Pratesi CB. The possible link between coeliac and Kawasaki diseases in Brazil: a cross-sectional study. BMJ Open 2018; 8:e018803. [PMID: 29444780 PMCID: PMC5829591 DOI: 10.1136/bmjopen-2017-018803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a self-limited acute systemic vasculitis of unknown aetiology that predominantly affects infants and young children eventually associated with immunological abnormalities. Coeliac disease (CD) is an inflammatory autoimmune disease characterised by a permanent gluten intolerance, which affects genetically susceptible individuals of any age group, and can cause intestinal and systemic symptoms. Association of CD with KD has been previously described in a single study that disclosed a surprisingly high prevalence of CD in children with a history of KD. OBJECTIVE To confirm the existence of a higher prevalence of CD among individuals with a history of KD, which would turn the screening for CD in patients with history of KD highly advisable. SETTING Children with history of KD, diagnosed and followed at the Rheumatology Clinic of the Children's Hospital of Brasilia (Brasilia, Brazil). PARTICIPANTS This study included 110 children with history of KD and a control group composed of 110 presumably healthy children. INTERVENTIONS Participants underwent anti-transglutaminase and anti-endomysial antibodies tests and genetic typing for the presence of CD predisposing alleles (HLA-DQ2 and DQ8). Jejunal biopsy was performed when necessary, according the European Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines. RESULTS Diagnosis of CD was confirmed in one (0.91%) patient with KD by positive serological tests, presence of predisposing alleles and CD typical lesions on duodenal biopsy. All serological tests were negative among the controls. The prevalence of CD predisposing alleles among patients with KD was 29.09%, similar to the prevalence found among controls, 33.64%. CONCLUSION The detected CD prevalence (0.91%) does not confirm the existence of an association between KD and CD since this prevalence is similar to that found in the general population (≃1%).
Collapse
Affiliation(s)
| | - Nicole Selleski
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia, Brazil
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Rosa Harumi Uenishi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia, Brazil
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia, Brazil
| | | | - Lenora Gandolfi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia, Brazil
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Claudia B Pratesi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia, Brazil
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia, Brazil
| |
Collapse
|
10
|
Laass MW, Schmitz R, Uhlig HH, Zimmer KP, Thamm M, Koletzko S. The prevalence of celiac disease in children and adolescents in Germany. Dtsch Arztebl Int 2016; 112:553-60. [PMID: 26356552 DOI: 10.3238/arztebl.2015.0553] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Untreated celiac disease is associated with increased morbidity and mortality. Until now, no up-to-date figures have been available on the prevalence of celiac disease among children and adolescents in Germany, or on the percentage of undiagnosed cases. METHODS To estimate the prevalence of celiac disease, serum samples obtained from 2003 to 2006 from participants in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were studied for celiac disease-specific autoantibodies and total IgA. RESULTS Of the 12 741 study participants aged 1 to 17 years (6546 boys, 6195 girls), 9 (0.07%) had a reported history of celiac disease. An elevated concentration of serum autoantibodies to tissue transglutaminase was found in 91 children with a normal IgA concentration and in 7 with IgA deficiency. The prevalence of undiagnosed celiac disease, based on positive autoantibody findings, was 0.8% (95% confidence interval 0.6-1.0%), and the overall prevalence of the disease was 0.9%. Seropositive children and adolescents had lower ferritin and red blood cell folate concentrations than seronegative ones; they also tended to be shorter and to weigh less as reflected by age- and sex-standardized z-scores. CONCLUSION The 0.9% prevalence of celiac disease in Germany, as determined from a combination of serological findings and clinical histories, is similar to reported prevalences elsewhere in Europe and North America. Pediatricians, primary care physicians, internists, and other specialists should be aware of the broad spectrum of clinical manifestations of this disease. Children who have symptoms suggestive of celiac disease or belong to a group at risk for it should be tested for antibodies against tissue transglutaminase, as should symptomatic adults after the exclusion of other possible causes. It is not yet clear whether asymptomatic adults from high-risk groups should be tested.
Collapse
Affiliation(s)
- Martin W Laass
- Institute and Outpatient Clinics of Pediatric and Adolescent Medicine, University Hospital Carl Gustav Carus, Dresden, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Translational Gastroenterology Unit and Department of Pediatrics, John Radcliffe Hospital, Oxford, United Kingdom, Department of General Pediatrics and Neonatology, Center for Pediatric and Adolescent Care, Justus Liebig University, Gießen, Epidemiology Laboratory, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Dr von Hauner Children's Hospital, Campus Innenstadt, Ludwig-Maximilians-Universität München
| | | | | | | | | | | |
Collapse
|
11
|
Vajpayee S, Sharma SD, Gupta R, Goyal A, Sharma A. Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease. Pediatr Gastroenterol Hepatol Nutr 2016; 19:229-235. [PMID: 28090467 PMCID: PMC5234418 DOI: 10.5223/pghn.2016.19.4.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/17/2016] [Accepted: 10/01/2016] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. METHODS It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. RESULTS Mean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. CONCLUSION Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.
Collapse
Affiliation(s)
- Shailja Vajpayee
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Shiv Dayal Sharma
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Rajkumar Gupta
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Alok Goyal
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Aakash Sharma
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| |
Collapse
|
12
|
ÇAKIR M, CEZAROĞLU S, ÇOBANOĞLU Ü. Celiac disease in children with chronic constipation. Turk J Med Sci 2016; 46:651-6. [DOI: 10.3906/sag-1502-130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/24/2015] [Indexed: 11/03/2022] Open
|
13
|
Laass MW, Schmitz R, Uhlig HH, Zimmer KP, Thamm M, Koletzko S. The prevalence of celiac disease in children and adolescents in Germany. Dtsch Arztebl Int 2015. [PMID: 26356552 DOI: 10.3238/arztebl.2015.0553.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Untreated celiac disease is associated with increased morbidity and mortality. Until now, no up-to-date figures have been available on the prevalence of celiac disease among children and adolescents in Germany, or on the percentage of undiagnosed cases. METHODS To estimate the prevalence of celiac disease, serum samples obtained from 2003 to 2006 from participants in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were studied for celiac disease-specific autoantibodies and total IgA. RESULTS Of the 12 741 study participants aged 1 to 17 years (6546 boys, 6195 girls), 9 (0.07%) had a reported history of celiac disease. An elevated concentration of serum autoantibodies to tissue transglutaminase was found in 91 children with a normal IgA concentration and in 7 with IgA deficiency. The prevalence of undiagnosed celiac disease, based on positive autoantibody findings, was 0.8% (95% confidence interval 0.6-1.0%), and the overall prevalence of the disease was 0.9%. Seropositive children and adolescents had lower ferritin and red blood cell folate concentrations than seronegative ones; they also tended to be shorter and to weigh less as reflected by age- and sex-standardized z-scores. CONCLUSION The 0.9% prevalence of celiac disease in Germany, as determined from a combination of serological findings and clinical histories, is similar to reported prevalences elsewhere in Europe and North America. Pediatricians, primary care physicians, internists, and other specialists should be aware of the broad spectrum of clinical manifestations of this disease. Children who have symptoms suggestive of celiac disease or belong to a group at risk for it should be tested for antibodies against tissue transglutaminase, as should symptomatic adults after the exclusion of other possible causes. It is not yet clear whether asymptomatic adults from high-risk groups should be tested.
Collapse
Affiliation(s)
- Martin W Laass
- Institute and Outpatient Clinics of Pediatric and Adolescent Medicine, University Hospital Carl Gustav Carus, Dresden, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Translational Gastroenterology Unit and Department of Pediatrics, John Radcliffe Hospital, Oxford, United Kingdom, Department of General Pediatrics and Neonatology, Center for Pediatric and Adolescent Care, Justus Liebig University, Gießen, Epidemiology Laboratory, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Dr von Hauner Children's Hospital, Campus Innenstadt, Ludwig-Maximilians-Universität München
| | | | | | | | | | | |
Collapse
|
14
|
Lionetti E, Gatti S, Pulvirenti A, Catassi C. Celiac disease from a global perspective. Best Pract Res Clin Gastroenterol 2015; 29:365-79. [PMID: 26060103 DOI: 10.1016/j.bpg.2015.05.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 01/31/2023]
Abstract
Celiac disease (CD) is one of the commonest lifelong disorders in countries populated by individuals of European origin, affecting approximately 1% of the general population. This is a common disease also in North Africa, Middle East and India. The widespread diffusion of CD is not surprising given that its causal factors (HLA predisposing genotypes and consumption of gluten-containing cereals) show a worldwide distribution. Further studies are needed to quantify the incidence of CD in apparently "celiac-free" areas such as Sub-Saharan Africa and Far East. Several reports have shown that CD is increasing in frequency in different geographic areas. Genetic factors do not explain the rising incidence during the last decades; environmental or lifestyle factors may be responsible for these changes over time. The majority of patients with CD are still undiagnosed all over the world, leading to debate about the need of screening program.
Collapse
Affiliation(s)
- Elena Lionetti
- Department of Paediatrics, University of Catania, Via S. Sofia 78, 95124 Catania, Italy.
| | - Simona Gatti
- Department of Paediatrics, Marche Polytechnic University, Ancona, Via Corridoni 11, 60123 Ancona, Italy.
| | - Alfredo Pulvirenti
- Department of Clinical and Molecular Biomedicine, University of Catania, Via S. Sofia 78, 95124 Catania, Italy.
| | - Carlo Catassi
- Department of Paediatrics, Marche Polytechnic University, Ancona, Via Corridoni 11, 60123 Ancona, Italy; The Division of Paediatric Gastroenterology and Nutrition, Center for Celiac Research, MassGeneral Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
15
|
Abstract
Wheat-related disorders have become a growing area of clinical and scientific interest and can be categorized broadly as: autoimmune-mediated; allergic; and non-autoimmune/non-allergic conditions. Non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) present on this spectrum as disorders associated with adverse gastrointestinal and extra-intestinal manifestations following exposure to gluten and/or other wheat-related constituents. NCGS/NCWS is increasingly considered in patients with unexplained symptoms after the exclusions of celiac disease and wheat allergy. As objective diagnostic data and specific biomarkers are lacking, response to a gluten-free/wheat-free diet can confirm the presence of NCGS/NCWS. An association with irritable bowel syndrome has been detected, and the effects of other food components, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, may contribute. Our organization and synthesis of extant knowledge pertaining to wheat-related disorders may advance current practice and research efforts toward an improved understanding of NCGS/NCWS as an evolving clinical entity.
Collapse
Affiliation(s)
- Renée M Marchioni Beery
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1845, USA
| | | |
Collapse
|
16
|
Abstract
In Europe and the USA, the mean frequency of celiac disease (CD) in the general population is approximately 1%, with some regional differences, the reasons for which remain elusive. A similar disease prevalence has been found in other countries mostly populated by individuals of European origin, e.g. Australia and Argentina. In Western countries, a true rise in overall CD prevalence of CD has been documented. CD is a common disorder in North Africa, the Middle East and India; however, the diagnostic rate is low in these countries due to low availability of diagnostic facilities and poor disease awareness. The highest CD prevalence in the world (5.6%) has been described in an African population originally living in Western Sahara, the Saharawi, of Arab-Berber origin. The reasons for this high CD frequency are unclear but could be primarily related to recent dietary changes and genetic factors, given the high level of consanguinity of this population. Further studies are needed to quantify the incidence of the celiac condition in apparently 'celiac-free' areas such as Sub-Saharan Africa and the Far East. In many developing countries, the frequency of CD is likely to increase in the near future given the diffuse tendency to adopt Western, gluten-rich dietary patterns. As most cases currently escape diagnosis all over the world, an effort should be made to increase the awareness of CD polymorphism. A cost-effective case-finding policy and new strategies of mass CD screening could significantly reduce the morbidity and mortality associated with untreated disease. The current high prevalence of CD is just the last link in a chain of events started about 10,000 years ago after wheat domestication and diffusion from the Middle East. We hypothesize different mechanisms to explain the so-called evolutionary celiac paradox of co-localization of gluten consumption and HLA CD-predisposing genotypes.
Collapse
|
17
|
Gokce S, Arslantas E. Changing face and clinical features of celiac disease in children. Pediatr Int 2015; 57:107-12. [PMID: 25040342 DOI: 10.1111/ped.12448] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/01/2014] [Accepted: 07/03/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to analyze and compare the epidemiological and presenting features, clinical patterns, and complications of celiac disease (CD) in children. METHODS The clinical charts of children with CD were retrospectively analyzed. Data for children who presented during the first time period (January 2005-October 2008; group 1) were compared to those of children who presented during the second time period (November 2008-April 2012; group 2). RESULTS Group 1 and 2 consisted of 96 and 95 children, respectively. There were no differences in gender distribution, weight, or height z-scores between the two groups. Mean age at the time of diagnosis in group 2 (9.3 ± 4.5 years) was significantly higher than in group 1 (6.9 ± 3.9 years; P < 0.001). Non-classical presentation was more frequent in group 2 (P = 0.01). Associated disorders were observed in 49 children (25.7%) overall. There were significantly more children with type 1 diabetes mellitus in group 2 (P = 0.030). In all, 11 patients (5.8%) were overweight (either obese or at risk of obesity) at presentation. Isolated short stature was the presenting feature in 15 children (7.9%) overall, but was more frequently observed in group 2 (P = 0.003). In total, 15 patients (7.9%) presented with refractory iron deficiency anemia; the frequency was similar in both groups. Dual-energy X-ray absorptiometry was performed in 102 patients, and 82 (80.4%) had metabolic bone disease (MBD). CONCLUSION The mode of presentation and clinical features of CD in childhood continue to change. Of note, a substantial percentage of patients were overweight at presentation. MBD is a frequent complication, necessitating routine evaluation.
Collapse
Affiliation(s)
- Selim Gokce
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University, Istanbul, Turkey
| | | |
Collapse
|
18
|
Lionetti E, Catassi C. Co-localization of gluten consumption and HLA-DQ2 and -DQ8 genotypes, a clue to the history of celiac disease. Dig Liver Dis 2014; 46:1057-63. [PMID: 25200477 DOI: 10.1016/j.dld.2014.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 12/11/2022]
Abstract
Celiac disease is an immune-mediated disorder triggered by gluten in genetically susceptible persons. Despite its detrimental effects on human health, it has not disappeared over time. The current evolutionary theory is that celiac disease is more common in areas reached later by agricultural revolution than in countries that started consumption of wheat earlier, due to negative selection caused by celiac disease. We reviewed data on worldwide prevalence of celiac disease, wheat consumption, and frequencies of HLA-celiac-disease-predisposing-genotypes to investigate their mutual relationship. Studies assessing prevalence of celiac disease were identified through a MEDLINE search. Wheat consumption and frequencies of HLA-DQ2-DQ8 were obtained from Food and Agriculture Organization of the United Nations and allelefrequencies.net database. Correlations between celiac disease, wheat consumption, and HLA were analyzed by linear regression. We observed a significant correlation between wheat consumption and HLA DQ2 (p=0.01) and the sum of DQ2 and DQ8 (p=0.01) frequencies. Wheat consumption and HLA-DQ2 tend to co-localize in different continents. The correlation between the prevalence of celiac disease and either DQ2 and/or DQ8, or the product of DQ2+DQ8*wheat consumption was not statistically significant. Co-localization of gluten consumption and HLA-celiac-disease-predisposing-genotypes can be explained by positive selection of HLA-DQ2 genes in wheat-consuming areas, and "demic diffusion" of Middle East farmers into Europe.
Collapse
Affiliation(s)
- Elena Lionetti
- Department of Pediatrics, University of Catania, Catania, Italy.
| | - Carlo Catassi
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Division of Pediatric Gastroenterology and Nutrition and Center for Celiac Research, Massachusetts General Hospital for Children, and Celiac Program - Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
|
20
|
Makharia GK, Mulder CJJ, Goh KL, Ahuja V, Bai JC, Catassi C, Green PHR, Gupta SD, Lundin KEA, Ramakrishna BS, Rawat R, Sharma H, Sood A, Watanabe C, Gibson PR. Issues associated with the emergence of coeliac disease in the Asia–Pacific region: a working party report of the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology. J Gastroenterol Hepatol 2014; 29:666-77. [PMID: 24783246 DOI: 10.1111/jgh.12514] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Once thought to be uncommon in Asia, coeliac disease (CD) is now being increasingly recognized in Asia–Pacific region. In many Asian nations, CD is still considered to be either nonexistent or very rare. In recognition of such heterogeneity of knowledge and awareness, the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology commissioned a working party to address the key issues in emergence of CD in Asia. METHODS A working group consisting of members from Asia–Pacific region, Europe, North America, and South America reviewed relevant existing literature with focus on those issues specific to Asia–Pacific region both in terms of what exists and what needs to be done. RESULTS The working group identified the gaps in epidemiology, diagnosis, and management of CD in Asian–Pacific region and recommended the following: to establish prevalence of CD across region, increase in awareness about CD among physicians and patients, and recognition of atypical manifestations of CD. The challenges such as variability in performance of serological tests, lack of population-specific cut-offs values for a positive test, need for expert dietitians for proper counseling and supervision of patients, need for gluten-free infrastructure in food supply and creation of patient advocacy organizations were also emphasized. CONCLUSIONS Although absolute number of patients with CD at present is not very large, this number is expected to increase over the next few years or decades. It is thus appropriate that medical community across the Asia–Pacific region define extent of problem and get prepared to handle impending epidemic of CD.
Collapse
|
21
|
Heymann AD, Leshno M, Endevelt R, Shamir R. The high cost of celiac disease in an Israeli Health Maintenance Organization. Health Econ Rev 2013; 3:23. [PMID: 24229448 PMCID: PMC4177202 DOI: 10.1186/2191-1991-3-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 10/25/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The aim of this study was to identify costs in patients diagnosed with Celiac disease. METHODS This retrospective case control study covered the period 2003-2006 and was conducted in a large Israeli Health Maintenance Organization insuring over two million members. Our cohort comprised 1,754 patients with Celiac disease with a control group of 15,040. Costs were aggregated according to main cost-branches and computed individually for each member. A linear step wise regression was performed with costs being the dependent variable and the independent variables; age, gender and the presence of celiac disease. Costs were compared with patients suffering from other chronic diseases. RESULTS The total costs of the patients with celiac disease were significantly higher than that of the control group for hospital admission, medications, laboratory and imaging. Hospital admission rate was 7.98% as opposed to 7.1% for the control group (p = 0.06). When compared with other chronic illnesses, the costs of patients with celiac disease were similar to those of patients with diabetes and hypertension. CONCLUSIONS Patients with Celiac disease utilize medical services more than the general population. This research suggests that the use of medical resources by patients with Celiac disease may be higher than previously thought.
Collapse
Affiliation(s)
- Anthony D Heymann
- The Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Leshno
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Faculty of Management, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Endevelt
- The Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- School of Public health University of Haifa, Haifa, Israel
| | - Raanan Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| |
Collapse
|
22
|
Biesiekierski JR, Muir JG, Gibson PR. Is Gluten a Cause of Gastrointestinal Symptoms in People Without Celiac Disease? Curr Allergy Asthma Rep 2013; 13:631-8. [DOI: 10.1007/s11882-013-0386-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|