Brief Article
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World J Gastroenterol. Sep 14, 2013; 19(34): 5658-5664
Published online Sep 14, 2013. doi: 10.3748/wjg.v19.i34.5658
Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets
Lorenzo Norsa, Raanan Shamir, Noam Zevit, Elvira Verduci, Corina Hartman, Diana Ghisleni, Enrica Riva, Marcello Giovannini
Lorenzo Norsa, Elvira Verduci, Diana Ghisleni, Enrica Riva, Marcello Giovannini, Department of Pediatrics, San Paolo Hospital University of Milan, 20142 Milan, Italy
Lorenzo Norsa, Raanan Shamir, Noam Zevit, Corina Hartman, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
Raanan Shamir, Noam Zevit, Corina Hartman, Sackler Faculty of Medicine, Tel-Aviv University, 39040 Tel Aviv, Israel
Elvira Verduci, Diana Ghisleni, Enrica Riva, Marcello Giovannini, Università degli Studi di Milano, 20142 Milano, Italy
Author contributions: Norsa L, Verduci E, Giovannini M and Riva E designed the research; Norsa L, Shamir R, Zevit N, Hartman C and Ghisleni D performed the research; Norsa L, Shamir R and Verduci E analyzed the data; Norsa L, Shamir R, Verduci E and Zevit N wrote the paper.
Correspondence to: Dr. Lorenzo Norsa, MD, Department of Pediatrics, San Paolo Hospital University of Milan, Via Di Rudinì 8, 20142 Milano, Italy. lonorsa@hotmail.com
Telephone: +39-33-56208168 Fax: +39-2-89150125
Received: March 5, 2013
Revised: May 8, 2013
Accepted: June 18, 2013
Published online: September 14, 2013
Abstract

AIM: To describe the cardiovascular disease (CVD) risk factors in a population of children with celiac disease (CD) on a gluten-free diet (GFD).

METHODS: This cross-sectional multicenter study was performed at Schneider Children’s Medical Center of Israel (Petach Tiqva, Israel), and San Paolo Hospital (Milan, Italy). We enrolled 114 CD children in serologic remission, who were on a GFD for at least one year. At enrollment, anthropometric measurements, blood lipids and glucose were assessed, and compared to values at diagnosis. The homeostasis model assessment-estimated insulin resistance was calculated as a measure of insulin resistance.

RESULTS: Three or more concomitant CVD risk factors [body mass index, waist circumference, low density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and insulin resistance] were identified in 14% of CD subjects on a GFD. The most common CVD risk factors were high fasting triglycerides (34.8%), elevated blood pressure (29.4%), and high concentrations of calculated LDL cholesterol (24.1%). On a GFD, four children (3.5%) had insulin resistance. Fasting insulin and HOMA-IR were significantly higher in the Italian cohort compared to the Israeli cohort (P < 0.001). Children on a GFD had an increased prevalence of borderline LDL cholesterol (24%) when compared to values (10%) at diagnosis (P = 0.090). Trends towards increases in overweight (from 8.8% to 11.5%) and obesity (from 5.3% to 8.8%) were seen on a GFD.

CONCLUSION: This report of insulin resistance and CVD risk factors in celiac children highlights the importance of CVD screening, and the need for dietary counseling targeting CVD prevention.

Keywords: Celiac disease, Cardiovascular disease risk factors, Gluten-free diet, Insulin resistance, Children, Hyperlipidemia, Cholesterol

Core tip: In our study we demonstrate a relatively high proportion of children with celiac disease (CD) adherent to a gluten-free diet (GFD) with one or more cardiovascular disease (CVD) risk factors. Furthermore, this is the first report of insulin resistance in celiac patients either in adults or children. These findings suggest that screening for CVD risk factors in celiac children both at diagnosis and during follow-up is important. Furthermore, dietary counseling over time, targeting obesity and CVD risk factors in addition to monitoring adherence to a GFD in children and adolescents diagnosed with CD, may be warranted.