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Hornik E, Imdad S, Chawla A, Zhang X, Small-Harary L. Effect of BMI and symptoms at celiac disease diagnosis on serology normalization after 2 years of a gluten-free diet in children. J Pediatr Gastroenterol Nutr 2025; 80:455-461. [PMID: 39749729 DOI: 10.1002/jpn3.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 12/06/2024] [Accepted: 12/14/2024] [Indexed: 01/04/2025]
Abstract
OBJECTIVES To determine if after 2 years of consuming a gluten-free diet post celiac disease diagnosis, pediatric patients who were overweight or obese at diagnosis are less likely to normalize celiac disease serologies as compared with those who were normal weight or underweight at diagnosis. Secondary aims include characterizing how initial symptoms at presentation predict body mass index (BMI) change and serology improvement over the first 2 years of being on a gluten-free diet following diagnosis of celiac disease. METHODS A retrospective chart review was performed that included all biopsy-proven celiac disease patients followed at Stony Brook Children's Hospital's Celiac Disease Center diagnosed between the years 2007-2022. This included all patients between 2 and 18 years of age who had their BMI documented at the time of diagnosis and at least one additional BMI documented 2 years ± 12 months after starting the gluten-free diet. Data collected included BMI and celiac serology at and 2 years ± 12 months after diagnosis as well as symptoms, sex, age, race, and ethnicity at diagnosis. RESULTS The charts of 229 pediatric patients with Celiac Disease were reviewed. Out of 229 patients, 89 had BMIs and celiac serologies available at diagnosis and at 2-year follow-up which were included. Based on multivariable logistic regression model, patients with overweight or obese BMI at baseline were not less likely (odds ratio [OR] = 0.97, 95% confidence interval [CI]: 0.29-3.27) to normalize their celiac serologies at 2-year follow-up visit as compared with patients who were normal weight or underweight at baseline. Patients with GI symptoms at diagnosis were more likely (OR = 3.86, 95% CI: 1.29, 11.54) to normalize their celiac serologies at 2-year follow-up visit as compared with patients without GI symptoms at diagnosis. CONCLUSIONS Rate of normalization of celiac serologies 2 years after initiating a gluten-free diet showed no difference between the overweight or obese and normal weight or underweight pediatric populations. However, patients with GI symptoms at diagnosis were more likely to normalize their celiac serologies by 2-year follow-up visit, suggesting they may be more likely to comply with the gluten-free diet.
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Affiliation(s)
- Ezra Hornik
- Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Sameer Imdad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stony Brook Children's Hospital, Stony Brook, USA
| | - Anupama Chawla
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stony Brook Children's Hospital, Stony Brook, USA
| | - Xiaoyue Zhang
- Biostatistical Consulting Core, Office of Scientific Affairs, Stony Brook School of Medicine, Stony Brook, USA
| | - Lesley Small-Harary
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stony Brook Children's Hospital, Stony Brook, USA
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Seidita A, Latteri F, Pistone M, Giuliano A, Bertoncello L, Cavallo G, Chiavetta M, Faraci F, Nigro A, Termini A, Verona L, Ammannato A, Accomando S, Cavataio F, Lospalluti ML, Citrano M, Di Liberto D, Soresi M, Mansueto P, Carroccio A. Celiac Disease and Liver Damage: The Gut-Liver Axis Strikes Back (Again)? A Retrospective Analysis in the Light of a Literature Review. Nutrients 2024; 17:85. [PMID: 39796519 PMCID: PMC11722968 DOI: 10.3390/nu17010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 12/23/2024] [Accepted: 12/26/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: An increasing number of studies have reported liver involvement in both children and adults with celiac disease (CD). This often manifests as isolated hypertransaminasemia or hepatic steatosis (HS). The aim of this study was to define the prevalence of hypertransaminasemia and HS in a pediatric population with CD before starting a gluten-free diet (GFD) and to analyze how the introduction of a GFD could modify this condition. We also conducted a state-of-the-art literature review of the association between hypertransaminasemia, metabolic dysfunction-associated steatotic liver disease (MASLD) and CD. Methods: We retrospectively reviewed the clinical charts of pediatric CD patients diagnosed in three different pediatric units of Sicily, analyzing clinical, laboratory, ultrasound, and histology data before and 12 months after the introduction of a GFD. Results: A total of 160 patients (65.0% females, median age 6.4 (0.8-13.2) years) were included; hypertransaminasemia and HS prevalences at diagnosis were 8.1% and 6.1%, respectively. Subjects with hypertransaminasemia were younger (p = 0.01) than those without and had higher frequencies of HS (p = 0.034) and anti-tissue transglutaminase (tTg) immunoglobulin (Ig)G positivity (p = 0.046). Subjects with HS were younger (p = 0.0001) and had a higher frequency of hypertransaminasemia (p = 0.029) compared to non-steatotic ones. After 12 months of a GFD, hypertransaminasemia and HS persisted in 53.8% and 50.0% of patients, respectively. Conclusions: The prevalences of hypertransaminasemia and HS in Sicilian pediatric CD patients seem to be lower than those reported in other geographical areas. A GFD can reverse the trend of liver involvement, although periods of longer than 12 months may be necessary. However, a GFD has been associated with an increased prevalence of HS, and so regular follow-up involving a nutritionist should be recommended to guide physicians in patient management.
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Affiliation(s)
- Aurelio Seidita
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Federica Latteri
- Gastroenterology Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy
| | - Mirco Pistone
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Alessandra Giuliano
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Luca Bertoncello
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Giorgia Cavallo
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Marta Chiavetta
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Francesco Faraci
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Alessia Nigro
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Alessandro Termini
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Laura Verona
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Agnese Ammannato
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Salvatore Accomando
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
- Department of Pediatrics, University Hospital of Palermo, 90134 Palermo, Italy
| | - Francesca Cavataio
- Pediatric Gastroenterology Unit, “Di Cristina” Hospital, Palermo, 90134 Palermo, Italy
| | | | - Michele Citrano
- Pediatrics Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy
| | - Diana Di Liberto
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy
| | - Maurizio Soresi
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Pasquale Mansueto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Antonio Carroccio
- Internal Medicine Unit, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco, 180, 90146 Palermo, Italy; (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
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Kasem Ali Sliman R, Stein N, Elenberg Alter Y. Celiac in the twenty-first century-the change in BMI of children at diagnosis over the last two decades. Eur J Pediatr 2024; 184:105. [PMID: 39722061 PMCID: PMC11669609 DOI: 10.1007/s00431-024-05835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/31/2024] [Accepted: 10/30/2024] [Indexed: 12/28/2024]
Abstract
This study examined the prevalence of different BMI categories among newly diagnosed pediatric celiac disease (CD) patients in Israel from 2002 to 2018. A retrospective cross-sectional study using the database of Clalit Health Services in Israel included 5520 newly diagnosed CD children aged 2-18 between 2002 and 2018. Data on BMI, gender, ethnicity, and socioeconomic status (SES) were collected and analyzed Of the 5520 CD patients, 57.5% were female, 39.7% had low SES, and 77.1% were Jewish. At diagnosis, 13.1% were underweight, 73% had normal BMI, 9.1% overweight, and 4.8% were obese. Underweight and obese patients tended to be older at diagnosis (9 years) compared with normal and overweight patients (8 years) (P < 0.001). A higher proportion of Arab patients were underweight, while more Jewish patients were obese. Lower SES was significantly associated with increased underweight risk (P < 0.001). Over time, diagnosed patients had improved SES and were less underweight (P < 0.001). Male gender increased obesity risk (OR 1.36 [95% CI 1.06-1.74], P = 0.017), while Arab ethnicity was protective for obesity (OR 0.67 [95% CI, (0.45-0.99)], P = 0.047)Conclusion: Underweight prevalence significantly decreased in the second decade, but no significant change in overweight and obesity was noted. Underweight was associated with older age at diagnosis, poverty, and Arab ethnicity. Obesity was associated with older age and was more frequent in Jewish and male patients. Physicians should have a low threshold for CD screening regardless of BMI status to enable timely diagnosis and treatment to prevent long-term health consequences. What Is Known: • Celiac disease is traditionally associated with underweight due to malabsorption, but recent reports suggest an increasing prevalence of overweight and obesity in pediatric patients at diagnosis What Is New: • This study found that underweight prevalence decreased significantly over time, while overweight and obesity prevalence remained unchanged. Underweight was associated with older age, poverty, and Arab ethnicity, while obesity was more common in Jewish and male patients.
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Affiliation(s)
- Rim Kasem Ali Sliman
- Technion - Israel Institute of Technology, Haifa, Israel.
- Department of Pediatrics, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel.
| | - Nili Stein
- Data Research and Statistician Center, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel
| | - Yigal Elenberg Alter
- Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pediatrics, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel
- Pediatric Gastroenterology Unit, Carmel Medical Center, Haifa, Israel
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Subedi R, Soulat A, Rauf Butt S, Mohan A, Danish Butt M, Arwani S, Ahmed G, Majumder K, Mohan Lal P, Kumar V, Tejwaney U, Ram N, Kumar S. Exploring the association between atrial fibrillation and celiac disease: a comprehensive review. Ann Med Surg (Lond) 2024; 86:7155-7163. [PMID: 39649916 PMCID: PMC11623827 DOI: 10.1097/ms9.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 05/10/2024] [Indexed: 12/11/2024] Open
Abstract
Objective This paper aims to provide a comprehensive overview of the pathophysiology of atrial fibrillation (AF) and celiac disease (CD) individually while also exploring the emerging evidence of a potential association between the two conditions. Methods The pathophysiology of AF, the most prevalent arrhythmia globally, and CD, an autoimmune condition triggered by gluten consumption, is examined. Genetic, structural, electrophysiological, and inflammatory factors contributing to their development are explored. Results AF involves irregular atrial activity leading to electrical and structural remodeling of the atrium. CD is characterized by an immune response to gluten, primarily associated with HLA-DQ2 and HLA-DQ8 genetic mutations, resulting in damage to intestinal tissue. Emerging research suggests a link between AF and CD, possibly mediated through inflammation, fibrosis, and electromechanical delays in the atrium. Conclusion Understanding the association between AF and CD carries significant clinical implications. Recognition of this relationship can assist in identifying individuals at higher risk for AF and inform proactive management strategies. Additionally, it underscores the importance of comprehensive care for CD patients, considering potential cardiac implications. Further research is warranted to elucidate precise mechanisms and explore potential therapeutic interventions targeting common pathways, opening avenues for enhanced patient care and future investigations.
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Affiliation(s)
- Rasish Subedi
- Universal College of Medical Sciences, Siddharthanagar
| | | | | | | | | | | | | | | | | | | | | | - Nanik Ram
- Aga Khan University Hospital, Karachi
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Peleg N, Niv Y, Dickman R, Boltin D, Krauthammer A, Herman-Edelstein M, Issa N, Ollech JE, Konikoff T, Gingold-Belfer R. The Effects of Gluten-free Diet on Body Mass Indexes in Adults with Celiac Disease: A Systematic Review and Meta-analysis of Observational Studies. J Clin Gastroenterol 2024; 58:989-997. [PMID: 38546459 DOI: 10.1097/mcg.0000000000001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/26/2024] [Indexed: 12/25/2024]
Abstract
GOALS AND BACKGROUND Gluten-free diet (GFD) includes a higher intake of sugars and fats. Previous studies have investigated its effect on body mass index (BMI) in celiac disease (CD) patients but had contradictive conclusions. Thus, we conducted a systematic review and meta-analysis examining the effect of GFD on BMI in CD patients. STUDY Systematically, we conducted literature research using Medline, Scopus, and Embase, and we identified 1565 potential studies/abstracts. Only studies of patients with CD under a GFD with recorded BMI before and after dietary intervention were included. Subgroup analyses based on study design and BMI categories were performed. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (Cls) for the number of patients in each BMI group according to the World Health Organization (WHO) definitions after GFD using fixed and random effect meta-analysis. RESULTS The analysis included 10 studies and 38 sub-studies/data sets, which encompassed 2450 patients from 5 countries. We found nonsignificant odds for changing the BMI group (pooled OR 0.972, 95% CI: 0.858-1.101, P =0.65) after GFD. However, looking specifically at BMI subgroups, we found higher odds for BMI category change after GFD in underweight patients (OR 0.588, 95% CI: 0.479-0.723, P <0.001), and overweight patients,25 CONCLUSION Although crucial in patients with CD, GFD is associated with increased BMI in some CD patient populations. Accordingly, special considerations and follow-up should be maintained in overweight patients with CD after GFD.
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Affiliation(s)
- Noam Peleg
- The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Yaron Niv
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Ram Dickman
- The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Doron Boltin
- The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Alex Krauthammer
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hasomer
| | - Michal Herman-Edelstein
- Department of Nephrology, Rabin Medical Center - Hasharon Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Nidal Issa
- Department of Surgery B, Rabin Medical Center - Hasharon Hospital, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Jacob E Ollech
- The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Tom Konikoff
- The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
| | - Rachel Gingold-Belfer
- The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv
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Milstein Y, Haiimov E, Slae M, Davidovics Z, Millman P, Birimberg-Schwartz L, Benson A, Wilschanski M, Amer R. Increased Risk of Celiac Disease in Patients with Uveitis. Ocul Immunol Inflamm 2024; 32:1330-1334. [PMID: 37579242 DOI: 10.1080/09273948.2023.2243497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To examine whether patients with non-infectious uveitis (NIU) are at increased risk for celiac disease (CeD). METHODS Celiac antibody testing was completed in 112 patients. The control group included patients who had undergone upper endoscopy for suspicion of CeD. RESULTS 2/112 (1.79%) of patients with NIU had positive anti-tTG serology and CeD was confirmed in both patients. When compared to the expected risk of CeD in the general Israeli population of 0.31%, this corresponded to an odds ratio of 5.77 (95% CI 1.4118 to 23.4737, P = 0.049). Three additional patients had positive serology for CeD but the diagnosis was not confirmed. CONCLUSIONS An increased risk of CeD was detected in patients with NIU. We therefore recommend screening for CeD in NIU patients. Larger prospective studies are required to further validate these results.
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Affiliation(s)
- Yosef Milstein
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Elianora Haiimov
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Slae
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zev Davidovics
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peri Millman
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liron Birimberg-Schwartz
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Hadassah Organoid Center, Hadassah Medical Organization, Jerusalem, Israel
| | - Ariel Benson
- Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Wilschanski
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Almahmoud E, Alkazemi DUZ, Al-Qabandi W. Growth Stunting and Nutritional Deficiencies among Children and Adolescents with Celiac Disease in Kuwait: A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1042. [PMID: 39334575 PMCID: PMC11429790 DOI: 10.3390/children11091042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/14/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND/OBJECTIVES This study aimed to assess the nutritional status of children and adolescents with celiac disease (CD) in Kuwait and investigate the nutritional deficiencies and sociodemographic factors associated with growth stunting in this population. METHODS This case-control study included 77 CD patients aged 3-18 years diagnosed with CD using IgA anti-tissue transglutaminase and duodenal biopsy and 33 healthy controls. Nutritional status was evaluated based on demographic and clinical characteristics, anthropometric measurements, and biochemical parameters. Univariate and multivariate logistic regression models were used to determine the association between CD and growth stunting. RESULTS Approximately one-third (31%) of children with CD had stunted growth, 20.8% had a low body mass index for their age, and 5.2% had both growth stunting and wasting. Children with CD had higher odds of iron-deficiency anemia, vitamin D deficiency, anemia, and lower socioeconomic status. They were also younger and had decreased serum levels of vitamin D compared to the controls. These factors were all significantly associated with an increased risk of CD, collectively explaining over 50% of the risk. For growth stunting, lower education status among mothers, family income, and serum ferritin were identified as risk factors. CONCLUSIONS A significant proportion of children and adolescents with CD had malnutrition, overt deficiencies, and impaired growth despite coherence with a gluten-free diet. RECOMMENDATION Routine monitoring and targeted nutritional interventions are recommended for children and adolescents with CD to address malnutrition and growth stunting. Addressing socioeconomic disparities and enhancing maternal education may also help mitigate the risk factors.
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Affiliation(s)
- Esraa Almahmoud
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, P.O. Box 17438, Al-Shadadiya 72455, Kuwait
| | - Dalal Usamah Zaid Alkazemi
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, P.O. Box 17438, Al-Shadadiya 72455, Kuwait
| | - Wafaa Al-Qabandi
- Department of Pediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, Jabriya 90805, Kuwait
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Monzani A, Marcolin S, Medina F, Valentino K, Rabbone I. BMI Status of Children with Celiac Disease Has Changed in the Last Decades: A 30-Year Retrospective Study. Nutrients 2024; 16:2729. [PMID: 39203865 PMCID: PMC11356937 DOI: 10.3390/nu16162729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/07/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
The presenting pattern of celiac disease (CD) at diagnosis in children has changed over time, with a reduction of malabsorption-related phenotypes and an increase in regular or even excessive growth patterns. We retrospectively reviewed the body mass index (BMI) distribution of all patients with a new diagnosis of CD made in a Pediatric Gastroenterology Outpatient Clinic in 1990-2011, compared to those diagnosed in 2012-2022, according to their clinical and serological characteristics. The 1990-2011 and 2012-2022 cohorts included 250 (M:F = 90:160, mean age 7.3 ± 6.1 years) and 243 children (M:F = 81:162, mean age 7.1 ± 3.7 years, NS), respectively. The prevalence of underweight (UW) was higher in the 1990-2011 cohort (61/250, 24.4% in 1990-2011 vs. 31/243, 12.7% in 2012-2022, p = 0.0001), whereas that of overweight (OW) and obese (OB) subjects was significantly higher in 2012-2022 (10/250, 4% in 1990-2011 vs. 24/243, 9.9% in 2012-2022, p = 0.012, and 1/250, 0.4% in 1990-2011 vs. 8/243, 3.3% in 2012-2022, p = 0.018, respectively). In both cohorts, gastrointestinal symptoms were more frequent in OW/OB than in UW children (6/11, 54.5% vs. 5/61, 8.2% in 1990-2011, p < 0.0001, and 24/32, 75% vs. 10/31, 32.3%, p < 0.0001 in 2012-2022), and the extent of anti-transglutaminase antibody increase was similar in OW/OB and UW subjects. The prevalence of children with a normal or even high BMI at CD diagnosis has increased in the past three decades; therefore, CD should be suspected regardless of BMI status.
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Affiliation(s)
- Alice Monzani
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (F.M.); (K.V.); (I.R.)
| | - Silvia Marcolin
- Italian Celiac Association, Piedmont Section, 10136 Turin, Italy;
| | - Federico Medina
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (F.M.); (K.V.); (I.R.)
| | - Kevin Valentino
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (F.M.); (K.V.); (I.R.)
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; (F.M.); (K.V.); (I.R.)
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9
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Macedo L, Catarino M, Festas C, Alves P. Vulnerability in Children with Celiac Disease: Findings from a Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:729. [PMID: 38929308 PMCID: PMC11201835 DOI: 10.3390/children11060729] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
(1) Background: The scientific literature highlights that children diagnosed with celiac disease (CD) are at a heightened risk of experiencing physical, psychological, and social challenges, impacting their overall healthy childhood development. However, there remains a lack of a clear understanding regarding the factors that contribute to this vulnerability. The purpose of this study is to analyze and map the evidence on the sociopsychosomatic vulnerability of these children and identify gaps in this topic. (2) Methods: Following Joanna Briggs Institute's guidelines for scoping reviews, we executed a detailed search of key electronic databases and explored the grey literature to capture a broad spectrum of studies. Our focus was on identifying research that looked into the multiple dimensions of vulnerability-physical, psychological, and social-in children with CD. We included a diverse range of study designs as well as systematic reviews, ensuring a comprehensive analysis. The selection process was stringent, utilizing clearly defined inclusion and exclusion criteria. (3) Results: We identified 61 studies that met our inclusion criteria. The review highlighted significant adverse health outcomes in children with CD and elucidated various individual and environmental determinants that influenced these vulnerabilities. It also underscored the lack of assessment tools to evaluate the risk of health problems in this population. (4) Conclusions: The findings underscore a critical need for further research to deepen our understanding of the vulnerabilities associated with CD in children. Developing targeted assessment tools will be crucial in stratifying health risks and enhancing care strategies for this vulnerable population.
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Affiliation(s)
- Lúcia Macedo
- Âncora Community Care Unit, Gaia and Espinho Local Health Unit, 4430-037 Gaia, Portugal
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (C.F.); (P.A.)
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Marta Catarino
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
- Health Department, Polytechnic Institute of Beja, 7800-111 Beja, Portugal
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Constança Festas
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (C.F.); (P.A.)
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Paulo Alves
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (C.F.); (P.A.)
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
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10
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Krauthammer A, Guz-Mark A, Zevit N, Waisbourd-Zinman O, Silbermintz A, Mozer-Glassberg Y, Nachmias Friedler V, Rozenfeld Bar Lev M, Matar M, Shouval D, Shamir R. A significant increase in anthropometric indices during long-term follow-up of pediatric patients with celiac disease, with no endocrine disorders. Eur J Pediatr 2024; 183:2173-2182. [PMID: 38376595 DOI: 10.1007/s00431-024-05477-8] [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: 12/01/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
Celiac disease (CeD) is likely to be associated with growth impairment and poor weight gain. However, long-term growth patterns following diagnosis are poorly characterized. We evaluated long-term anthropometric changes in a large cohort of pediatric patients with CeD. A retrospective chart review of patients diagnosed with CeD between 1999 and 2018 was conducted. Demographic and clinical data were collected, and anthropometrics were analyzed from diagnosis and throughout follow-up. The study included 500 patients (59.8% females, median (IQR) age at diagnosis 5.7 (3.7-8.9) years), with a mean follow-up of 5.5 (range 1.5-16.2) years. Weight, height, and BMI Z-score-for-age (WAZ, HAZ, and BMIZ) increased significantly from a mean (± SD) of - 0.82 (± 1.21), - 0.73 (± 1.16), and - 0.32 (± 1.11) at diagnosis to - 0.41 (± 1.23), - 0.45(± 1.16), and - 0.17 (± 1.14) at last follow-up, respectively (p < 0.001 for WAZ and HAZ and p = 0.002 for BMIZ). The largest improvements were observed in patients diagnosed before 3 years of age (p < 0.01). Patients for whom the final adult height was available (n = 86) improved from HAZ mean (± SD) - 0.89 ± 1.37 at diagnosis to - 0.51 ± 1.28 at adulthood measurement, p < 0.05. Wasting was present in 19.7% and stunting in 16.4% of the cohort at diagnosis and normalized in 77.3% and 64.8%, respectively, within a median (IQR) time of 0.79 (0.42-4.24) and 2.3 (0.72-6.02) years, respectively. Gluten-free diet adherence and frequency of visits were not associated with normalization of wasting or stunting in all age groups. Conclusion: Over a long-term follow-up, pediatric patients with CeD demonstrate significant increases in weight, height, and BMI-for-age. Younger age at diagnosis is associated with greater improvement in weight and linear growth, emphasizing the importance of early diagnosis of CeD. What is Known: • Celiac disease (СeD) is likely to be associated with growth impairment and poor weight gain. • Long-term changes in anthropometric indices after diagnosis of CeD are not well characterized. What is New: • Over a long-term follow-up, pediatric patients with CeD demonstrate significant increases in weight, height, and BMI-for-age. • Young age at diagnosis is associated with larger improvement in weight and linear growth.
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Affiliation(s)
- Alexander Krauthammer
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Anat Guz-Mark
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Zevit
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Waisbourd-Zinman
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Silbermintz
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
| | - Yael Mozer-Glassberg
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
| | - Vered Nachmias Friedler
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
| | - Michal Rozenfeld Bar Lev
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
| | - Manar Matar
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
| | - Dror Shouval
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Janatolmakan M, Zobeiri M, Rezaeian S, Rostami S, Akbari M, Khatony A. Epidemiology of Celiac Disease in Western Iran during 2019-2021. BIOMED RESEARCH INTERNATIONAL 2024; 2024:1112812. [PMID: 38665986 PMCID: PMC11045285 DOI: 10.1155/2024/1112812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Celiac disease is a growing global public health concern. This epidemiological study is aimed at determining the prevalence of celiac disease in Kermanshah, Western Iran, from 2019 to 2021, as well as the frequency of gastrointestinal and nongastrointestinal manifestations associated with the disease. In this cross-sectional study, the medical records of all patients with a confirmed diagnosis of celiac disease between 2019 and 2021 were reviewed. The average population during the study period was 2,058,545. A researcher-developed checklist was used as the data collection tool, and descriptive statistics were employed for data analysis. During the study period, there were 113 patients diagnosed with celiac disease, with a mean age of 29.1 ± 16.6 years. The three-year prevalence of celiac disease was 5.49 (95% CI: 5.17-5.82) per 100,000 population. Among these patients, 70% (n = 78) was female. The most common gastrointestinal manifestations of the disease were abdominal pain (77.8%), constipation (59.3%), and diarrhea (54.9%). Iron-deficiency anemia (64.6%) and vitamin D3 deficiency (46.1%) were the most common nongastrointestinal manifestations. Growth retardation was observed in 39.0% of patients. This study demonstrated a higher prevalence of celiac disease in Kermanshah compared to global statistics. Given the association of celiac disease with other conditions such as diabetes, irritable bowel syndrome, growth retardation, and iron-deficiency anemia, healthcare providers should consider screening patients for celiac disease. Furthermore, community-based education is crucial in raising awareness about the significance of adhering to a proper diet and reducing wheat consumption.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Zobeiri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shima Rostami
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehnosh Akbari
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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12
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Penizzotto A, Vespa F, López Grove R, Rendón O, Tsai R, Ocantos JA. CT and MR Enterography in the Evaluation of Celiac Disease. Radiographics 2024; 44:e230122. [PMID: 38483832 DOI: 10.1148/rg.230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Celiac disease is a common inflammatory disease of the small bowel that induces mucosal intestinal lesions. The disease is mediated by an immune response and triggered by the ingestion of gluten in genetically predisposed individuals. Gluten contains gliadin, a component found mostly in wheat, barley, and rye. This process leads to gastrointestinal malabsorption with symptoms such as diarrhea, constipation, abdominal pain, and distention. It has a prevalence of 1%-2% in the general adult population, who present with symptoms at any age, but is more frequently found in adult women in the 3rd or 4th decade of life. Recognition of the disease has increased, but it remains a challenge to diagnose. CT and MR enterography are noninvasive studies used for evaluation of small bowel neoplasms and inflammatory small bowel pathologic conditions such as celiac disease. The authors review the spectrum of intestinal and extraintestinal findings of celiac disease at CT and MR enterography, as well as its complications, and the importance of recognizing certain imaging features that help in the diagnosis of celiac disease. More common and specific findings of celiac disease such as inversion of the jejunoileal fold pattern and mesenteric lymphadenopathy are reviewed. More uncommon entities that are more frequently associated with refractory or untreated celiac disease, such as ulcerative jejunoileitis, cavitary mesenteric lymph node syndrome, and malignancies including small bowel adenocarcinoma and lymphoma, are described. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Andrea Penizzotto
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Florencia Vespa
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Roy López Grove
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Omar Rendón
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Richard Tsai
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Jorge Alberto Ocantos
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
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13
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Jansson-Knodell CL, Rubio-Tapia A. Gluten-related Disorders From Bench to Bedside. Clin Gastroenterol Hepatol 2024; 22:693-704.e1. [PMID: 37879521 DOI: 10.1016/j.cgh.2023.09.042] [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: 08/15/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Celiac disease, non-celiac gluten sensitivity, and wheat allergy comprise 3 of the main conditions with wheat- and gluten-containing foods as the symptom trigger. Distinguishing between these entities can be daunting. In this review, we compare and contrast celiac disease, non-celiac gluten sensitivity, and wheat allergy to allow clinicians to determine which diagnosis fits their patient to facilitate high-quality management and longitudinal care.
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Affiliation(s)
- Claire L Jansson-Knodell
- Celiac Disease Program, Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alberto Rubio-Tapia
- Celiac Disease Program, Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
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14
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Martínez Gallego MÁ, Crespo Sánchez MG, Serrano Olmedo MG, Buño Soto A, Álvarez Casasempere S, Nozal P, Martínez-Ojinaga E, Molina Arias M, Losantos-García I, Molero-Luis M. Trends in Faecal Zonulin Concentrations in Paediatric Patients with Celiac Disease at Baseline and on a Gluten-Free Diet: Exploring Correlations with Other Faecal Biomarkers. Nutrients 2024; 16:684. [PMID: 38474812 DOI: 10.3390/nu16050684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Celiac disease (CeD) is an autoimmune condition triggered by gluten in genetically predisposed individuals, affecting all ages. Intestinal permeability (IP) is crucial in the pathogenesis of CeD and it is primarily governed by tight junctions (TJs) that uphold the intestinal barrier's integrity. The protein zonulin plays a critical role in modulating the permeability of TJs having emerged as a potential non-invasive biomarker to study IP. The importance of this study lies in providing evidence for the usefulness of a non-invasive tool in the study of IP both at baseline and in the follow-up of paediatric patients with CeD. In this single-centre prospective observational study, we explored the correlation between faecal zonulin levels and others faecal and serum biomarkers for monitoring IP in CeD within the paediatric population. We also aimed to establish reference values for faecal zonulin in the paediatric population. We found that faecal zonulin and calprotectin values are higher at the onset of CeD compared with the control population. Specifically, the zonulin levels were 347.5 ng/mL as opposed to 177.7 ng/mL in the control population (p = 0.001), while calprotectin levels were 29.8 μg/g stool compared to 13.9 μg/g stool (p = 0.029). As the duration without gluten consumption increased, a significant reduction in faecal zonulin levels was observed in patients with CeD (348.5 ng/mL vs. 157.1 ng/mL; p = 0.002), along with a decrease in the prevalence of patients with vitamin D insufficiency (88.9% vs. 77.8%). We conclude that faecal zonulin concentrations were higher in the patients with active CeD compared with healthy individuals or those following a gluten-free diet (GFD). The significant decrease in their values over the duration of the GFD suggests the potential use of zonulin as an additional tool in monitoring adherence to a GFD.
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Affiliation(s)
| | | | | | - Antonio Buño Soto
- Department of Laboratory Medicine, La Paz University Hospital, 28046 Madrid, Spain
| | | | - Pilar Nozal
- Department of Immunology, La Paz University Hospital, 28046 Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER U754), 28046 Madrid, Spain
- Complement Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain
| | - Eva Martínez-Ojinaga
- Paediatric Gastroenterology and Nutrition Service, La Paz University Hospital, 28046 Madrid, Spain
| | - Manuel Molina Arias
- Paediatric Gastroenterology and Nutrition Service, La Paz University Hospital, 28046 Madrid, Spain
| | | | - Marta Molero-Luis
- Department of Laboratory Medicine, La Paz University Hospital, 28046 Madrid, Spain
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15
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De Giuseppe R, Bergomas F, Loperfido F, Giampieri F, Preatoni G, Calcaterra V, Cena H. Could Celiac Disease and Overweight/Obesity Coexist in School-Aged Children and Adolescents? A Systematic Review. Child Obes 2024; 20:48-67. [PMID: 36602771 DOI: 10.1089/chi.2022.0035] [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] [Indexed: 01/06/2023]
Abstract
Background: Celiac disease (CD) is a multifactorial, immune-mediated enteropathic disorder that may occur at any age with heterogeneous clinical presentation. In the last years, unusual manifestations have become very frequent, and currently, it is not so uncommon to diagnose CD in subjects with overweight or obesity, especially in adults; however, little is known in the pediatric population. This systematic review aims to evaluate the literature regarding the association between CD and overweight/obesity in school-age children. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of articles published in the last 20 years in English was carried out in Web of Sciences, PubMed, and Medline. The quality of the included studies was assessed by using the STrengthening the Reporting of OBservational studies in Epidemiology statement. Results: Of the 1396 articles identified, 9 articles, investigating overweight/obesity in children/adolescents affected by CD or screening CD in children/adolescents with overweight/obesity, met the inclusion criteria. Overall, the results showed that the prevalence of overweight or obesity in school-age children (6-17 years) affected by CD ranged between 3.5% and 20%, highlighting that the coexistence of CD with overweight/obesity in children is not uncommon as previously thought. Conclusion: Although CD has been historically correlated with being underweight due to malabsorption, it should be evaluated also in children with overweight and obesity, especially those who have a familiar predisposition to other autoimmune diseases and/or manifest unusual symptoms of CD.
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Affiliation(s)
- Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesca Bergomas
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università degli Studi di Milano, Milano, Italy
| | - Federica Loperfido
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università degli Studi di Pavia, Pavia, Italy
| | - Francesca Giampieri
- Research Group on Food, Nutritional Biochemistry, and Health, Universidad Europea del Atlántico, Santander, Spain
| | - Giorgia Preatoni
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Unit, "V. Buzzi" Children's Hospital, Milano, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
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16
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Vereczkei Z, Imrei M, Szakács Z, Kővári B, Papp V, Lénárt Z, Berki T, Szirmay B, Farkas N, Balaskó M, Habon T, Hegyi P, Bajor J. Cardiovascular risk factors in coeliac disease (ARCTIC): a protocol of multicentre series of studies. BMJ Open 2023; 13:e068989. [PMID: 37709338 PMCID: PMC10503320 DOI: 10.1136/bmjopen-2022-068989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION There is only limited and controversial information available on the cardiovascular (CV) risk in coeliac disease (CD). In this study, we plan to investigate the body composition and CV risk-related metabolic parameters at the diagnosis of CD and on a gluten-free diet in a Hungarian cohort of patients with CD. METHODS AND ANALYSIS This study consists of two case-control studies and a prospective cohort study, involving newly diagnosed and treated patients with CD with age and sex-matched non-CD control subjects with an allocation ratio of 1:1. CD-related symptoms, quality of life, quality of the diet and CV risk will be assessed with questionnaires. Our primary outcomes are body composition parameters, which will be estimated with InBody 770 device. Secondary outcomes are CV-risk related metabolic parameters (eg, serum lipids, haemoglobin A1c, homeostatic model assessment index, liver enzymes, homocysteine, interleukin 6, galectin-3) and enteral hormones (leptin, ghrelin, adiponectin) measured from venous blood samples for all participants. Fatty liver disease will be assessed by transabdominal ultrasonography. In statistical analysis, descriptive and comparative statistics will be performed. With this study, we aim to draw attention to the often neglected metabolic and CV aspect of the management of CD. Findings may help to identify parameters to be optimised and reassessed during follow-up in patients with CD. ETHICS AND DISSEMINATION The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05530070.
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Affiliation(s)
- Zsófia Vereczkei
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Zsolt Szakács
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Bálint Kővári
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Veronika Papp
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Lénárt
- First Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, Medical School, University of Pecs, Pecs, Hungary
| | - Balázs Szirmay
- Department of Laboratory Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Institute of Bioanalysis, Medical School, University of Pecs, Pecs, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Tamás Habon
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Bajor
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
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Zelnik Yovel D, Berezovsky L, Richter V, Shalem T, Cohen DL, Shirin H, Broide E. Factors Associated With Adherence to a Gluten-Free Diet in Celiac Patients Diagnosed in Childhood as Compared to Adulthood. Gastroenterol Nurs 2023; 46:243-248. [PMID: 37053375 DOI: 10.1097/sga.0000000000000729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2022] [Indexed: 04/15/2023] Open
Abstract
Past studies have reported differences between pediatric and adult celiac disease patients. We aimed to compare factors associated with adherence to a gluten-free diet between these groups. An anonymous online questionnaire was sent via the Israeli Celiac Association and social networks to celiac patients. The Biagi questionnaire was used to assess dietary adherence. A total of 445 subjects participated. Mean age was 25.7 ± 17.5 years and 71.9% were female. Subjects were divided into six groups according to age at diagnosis: younger than 6 years (134 patients, 30.7%), 6-12 (79 patients, 18.1%), 12-18 (41 patients, 9.4%), 18-30 (81 patients, 18.5%), 30-45 (79 patients, 18.1%), and 45 years and above (23 patients, 5.3%). There were several significant differences between childhood- and adulthood-diagnosed patients. Pediatric patients were less likely to be noncompliant with a gluten-free diet (3.7% vs. 9.4%, p < .001). They were also more frequently followed by a gastroenterologist ( p < .001), a dietitian ( p < .001), and participated in a celiac support group ( p = .002). In logistic regression analyses, longer duration of disease was associated with poor compliance. In conclusion, pediatric-diagnosed celiac patients are more adherent to a gluten-free diet than those diagnosed in adulthood, with better social support and nutritional follow-up possibly contributing.
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Affiliation(s)
- Dana Zelnik Yovel
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Lena Berezovsky
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Vered Richter
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Tzippora Shalem
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Daniel L Cohen
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Haim Shirin
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Efrat Broide
- Dana Zelnik Yovel, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Lena Berezovsky, MD, is Pediatrician at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Tzippora Shalem, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Daniel L. Cohen, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel
- Efrat Broide, MD is Director of the Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
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Barone M, Iannone A, Cristofori F, Dargenio VN, Indrio F, Verduci E, Di Leo A, Francavilla R. Risk of obesity during a gluten-free diet in pediatric and adult patients with celiac disease: a systematic review with meta-analysis. Nutr Rev 2023; 81:252-266. [PMID: 35947766 PMCID: PMC10857815 DOI: 10.1093/nutrit/nuac052] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Obesity is a significant risk factor for many pathological conditions. Whether a gluten-free diet (GFD) is a risk factor for overweight or obesity remains controversial. OBJECTIVE The primary aim of this study was to assess the prevalence of body mass index (BMI) categories at disease presentation and the variation in BMI category from underweight/normal to overweight/obese and vice versa during a GFD. DATA SOURCES PubMed, Scopus, and Web of Science databases were searched through February 2021 for retrospective, cross-sectional, and prospective studies reporting BMI categories at disease diagnosis and during a GFD. DATA EXTRACTION Data were extracted by 2 reviewers independently. Disagreements were resolved by consensus; a third reviewer was consulted, if necessary. Risk of bias was assessed with the Cochrane ROBINS-I tool. DATA ANALYSIS Subgroup analysis based on age (pediatric/adult patients), study design (prospective, cross-sectional, retrospective), and duration of GFD was performed.. Forty-five studies were selected (7959 patients with celiac disease and 20 524 healthy controls). The mean BMI of celiac patients at presentation was significantly lower than that of controls (P < 0.001). During a GFD, the mean BMI increased significantly (mean difference = 1.14 kg/m2 [95%CI, 0.68-1.60 kg/m2]; I2 = 82.8%; P < 0.001), but only 9% of patients (95%CI, 7%-12%; I2 = 80.0%) changed from the underweight/normal BMI category to the overweight/obese category, while 20% (95%CI, 11%-29%; I2 = 85.8%) moved into a lower BMI category. CONCLUSION Most celiac patients had a normal BMI at presentation, although the mean BMI was significantly lower than that of controls. A GFD does not increase the risk of becoming overweight/obese, especially in children. The quality of several studies was suboptimal, with moderate or high overall risk of bias and heterogeneity.
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Affiliation(s)
- Michele Barone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Andrea Iannone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Fernanda Cristofori
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Vanessa Nadia Dargenio
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Flavia Indrio
- is with the Department of Pediatrics, Scientific Institute “Casa Sollievo della Sofferenza,” Foggia, Italy
| | - Elvira Verduci
- is with the Department of Pediatrics, Ospedale dei Bambini “Vittore Buzzi,” Milan, Italy
| | - Alfredo Di Leo
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Ruggiero Francavilla
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
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MAFLD and Celiac Disease in Children. Int J Mol Sci 2023; 24:ijms24021764. [PMID: 36675276 PMCID: PMC9866925 DOI: 10.3390/ijms24021764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Celiac disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten whose clinical presentation ranges from the asymptomatic form to clinical patterns characterized by multiple systemic involvement. Although CD is a disease more frequently diagnosed in patients with symptoms of malabsorption such as diarrhea, steatorrhea, weight loss, or failure to thrive, the raised rate of overweight and obesity among general pediatric and adult populations has increased the possibility to diagnose celiac disease in obese patients as well. Consequently, it is not difficult to also find obesity-related disorders in patients with CD, including "metabolic associated fatty liver disease" (MAFLD). The exact mechanisms linking these two conditions are not yet known. The going assumption is that a gluten-free diet (GFD) plays a pivotal role in determining an altered metabolic profile because of the elevated content of sugars, proteins, saturated fats, and complex carbohydrates, and the higher glycemic index of gluten-free products than gluten-contained foods, predisposing individuals to the development of insulin resistance. However, recent evidence supports the hypothesis that alterations in one of the components of the so-called "gut-liver axis" might contribute to the increased afflux of toxic substances to the liver triggering the liver fat accumulation and to the subsequent hepatocellular damage. The aim of this paper was to describe the actual knowledge about the factors implicated in the pathogenesis of hepatic steatosis in pediatric patients with CD. The presented review allows us to conclude that the serological evaluations for CD with anti-transglutaminase antibodies, should be a part of the general workup in the asymptomatic patients with "non-alcoholic fatty liver disease" (NAFLD) when metabolic risk factors are not evident, and in the patients with steatohepatitis when other causes of liver disease are excluded.
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Salarian L, Khavaran M, Dehghani SM, Mashhadiagha A, Moosavi SA, Rezaeianzadeh S. Extra-intestinal manifestations of Celiac disease in children: their prevalence and association with human leukocyte antigens and pathological and laboratory evaluations. BMC Pediatr 2023; 23:8. [PMID: 36597078 PMCID: PMC9811781 DOI: 10.1186/s12887-022-03826-w] [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: 07/30/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Celiac disease (CD) is an autoimmune disease caused by gluten intake. Traditionally CD was believed to be a disease of the gut, although a wide range of extra-intestinal manifestations (EIM) was recognized. The exact prevalence of EIM and the associated risk factors have not been well studied. AIM We aimed to assess the prevalence of EIM in children with CD and their association with human leukocyte antigen (HLA) typing, and pathological and laboratory indices. METHOD We conducted a cross-sectional study on children and adolescents with a definite diagnosis of CD. They were followed in the main Celiac Clinic of Southern Iran. RESULTS We included 204 children who were visited between 2012 and 2017. Nearly 85% of them were positive for HLA-DQ2 and 40.6% for HLA-DQ8. The most prevalent intestinal complaints reported were abdominal pain (42.6%) and chronic constipation (19.1%). Failure-to-thrive (32.7%), iron deficiency anemia (25%), short stature (20.5%), and eczema (18.6%) were the most common EIMs. However, failure-to-thrive and short stature were presented at significantly younger ages, whereas those patients with concomitant type 1 diabetes mellitus (DM) were significantly older. We also found significant relationships between autoimmune thyroid disease and HLA-DQ5, and the presence of headaches with HLA-DQ7. The prevalence of HLA types of DQ2, DQ8, DQ6, and DQ7 significantly varied among different Marsh groups. Patients who were positive for HLA-DQ8, were significantly older, taller, and weightier. No significant association was found between HLA types and any of the gastrointestinal symptoms, anti-tTG and compliance to gluten free diet. Moreover, there were no statistically significant differences detected between the presence of each individual EIM, the level of IgA anti-tTG, sex, and Marsh typing. CONCLUSION This study highlights the presence of EIM in CD and their associated factors. We show the potential role of HLA typing in some EIMs, which may shed light for future studies.
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Affiliation(s)
- Leila Salarian
- grid.412571.40000 0000 8819 4698Department of Pediatric Endocrinology, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Shiraz Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Khavaran
- grid.412571.40000 0000 8819 4698Department of Pediatric Endocrinology, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Dehghani
- grid.412571.40000 0000 8819 4698Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirali Mashhadiagha
- grid.412571.40000 0000 8819 4698Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Moosavi
- grid.412571.40000 0000 8819 4698Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shayan Rezaeianzadeh
- grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Muacevic A, Adler JR, Doğan AE, Özdener F. Factors Affecting Prognosis in the Course of Pediatric Celiac Disease. Cureus 2022; 14:e32208. [PMID: 36620822 PMCID: PMC9812003 DOI: 10.7759/cureus.32208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction Celiac disease (CD) is a rather frequent chronic autoimmune disease that causes impaired growth in children. The present study aims to evaluate patients' condition after diagnosis cross-sectionally and determine the factors affecting prognosis. Methods Control visits were performed at the end of the 13-month intervention period. The study was designed as a single-center retrospective study and included patients diagnosed with CD. The study cohort consisted of 211 patients aged 1 to 18 years. Statistical parameters include Helicobacter positivity, Marsh classification; economic status; and body mass index (BMI) z-score, weight z-score, and height z-score to observe the difference between admission and follow-up. Results Treatment adherence is one of the most critical factors influencing improvement in developmental parameters during control visits (p<0.033). It was observed that the weight z-scores at the control visit deteriorated significantly with a longer duration of complaints (p=0.033). Better improvement of control visit BMI z-scores among patients with complaints compared to asymptomatic patients (p=0.036) indicate the importance of early diagnosis in asymptomatic cases. Developmental parameters of patients with CD without growth retardation (GR) show faster improvement compared to patients with GR (p<0.001). Families with good socioeconomic status can easily adapt to the diet by reaching a greater variety of gluten-free products, so anthropometric measurements are observed to be significantly higher at the control visit (p<0.002). Conclusions Treatment adherence is the most critical factor for improvement in CD treatment, as in all treatments. In addition, the investigation of suspected, additional disease symptoms during the follow-up of a CD patient is also of great importance for early diagnosis. The importance of early diagnosis has been emphasized in terms of anthropometric improvement in asymptomatic CD cases.
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Nutritional Imbalances in Polish Children with Coeliac Disease on a Strict Gluten-Free Diet. Nutrients 2022; 14:nu14193969. [PMID: 36235620 PMCID: PMC9572580 DOI: 10.3390/nu14193969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Currently, the only treatment for coeliac disease (CD) is a strict, lifelong gluten-free diet (GFD); however, their completeness with regard to energy and macro- and micronutrients remains poorly understood. Paediatric studies are often limited by a low quality and a lack of controls, and their findings should be interpreted with caution. The aim of the present study was to evaluate nutritional imbalances in children with CD on a strict GFD. Methods: A single-centre prospective cohort study was conducted. A total of 48 children with CD (33 girls, mean age 11.8 ± 3.68 years) on a strict GFD (mean duration 5.02 ± 3.87 years) were compared with 50 non-coeliac subjects (26 girls, mean age 10.2 ± 3.97 years). In both groups, anthropometric measurements (body height, weight and BMI) and laboratory tests (haemoglobin level, calcium and magnesium serum concentration, folic acid, vitamin B1, B2, B6 and B12 level) were checked. Additionally, in coeliac subjects, a 3-day food record for energy and macro- and micronutrient intake assessment were determined, and the values were compared to those in non-CD participants and the dietary reference intake (DRI) standards. Results: The CD children were more likely to demonstrate significantly lower serum vitamin B1 and folic acid levels compared to controls (p = 0.01 and p = 0.002, respectively). Although mean serum calcium values were within normal ranges, they were significantly lower in CD subjects than controls (p = 0.01). Mean calcium, folic acid and vitamin D intake was below the dietary recommendations in the CD group (69.9%, 71.2% and 68.9% DRI, respectively) but did not differ significantly between CD and non-coeliac subjects. In turn, the mean supply of proteins and carbohydrates in the CD group substantially exceeded the recommended levels (190.3% and 189.4% DRI, respectively) but was similar to controls. A significantly higher number of CD children were classified as underweight, and a significantly lower number as overweight or obese, compared with controls (p < 0.001). Conclusion: Although children with CD receive nutritional education at diagnosis, a GFD often does not provide a balanced set of macro- and micronutrients. This is mainly due to unhealthy dietary habits, as commonly observed in the general population. Children with CD should be informed that while their diet should be free of gluten, it should nevertheless cover all their nutrition requirements in the long term.
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Raiteri A, Granito A, Faggiano C, Giamperoli A, Catenaro T, Negrini G, Tovoli F. Hepatic Steatosis in Patients with Celiac Disease: The Role of Packaged Gluten-Free Foods. Nutrients 2022; 14:2942. [PMID: 35889899 PMCID: PMC9316041 DOI: 10.3390/nu14142942] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023] Open
Abstract
Background: An increased risk of nonalcoholic fatty liver disease (NAFLD) in patients with celiac disease (CD) adhering to a gluten-free diet (GFD) was recently reported. The nutritional composition of packaged gluten-free foods (PGFF) has been proposed as a possible cause. This hypothesis has not been investigated further, since a systematic structural nutritional interview for all patients would be problematic in clinical practice. Methods: We administered a simple questionnaire based on a Recency, Frequency, and Monetary value (RFM) analysis (a cornerstone of direct marketing segmentation) to consecutive CD patients on a GFD for >6 months and verified its association with NAFLD. Subgroup analyses were performed to understand whether specific patterns of PGFF consumption were significantly associated with NAFLD. Results: Amongst 147 patients (female 82%, median age 42 years), 45 (30.6%) had NAFLD. Total RFM score (adjusted odds ratio = 1.223, 95% CI: 1.059−1.413, p = 0.006), body mass index, and total cholesterol and triglycerides were independently related to NAFLD, and “Bread and bakery” (p = 0.002), “salty convenience” (p = 0.005), and “sweet convenience” (p = 0.049) products were significantly related with NAFLD. Also, questions about the number of purchased PGFF in the last month (monetary value) and different categories of PGFF consumed in the last week (recency) were particularly able to identify NAFLD patients. Conclusions: The specific GFD dietary habits of CD patients were correlated with the degree of risk of NAFLD. Information was obtained through a questionnaire which could be used in clinical practice to favor a patient-tailored approach and in future studies to verify the reproducibility of our results in different geographical areas.
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Affiliation(s)
- Alberto Raiteri
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy; (A.R.); (A.G.); (C.F.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (A.G.); (T.C.); (G.N.)
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy; (A.R.); (A.G.); (C.F.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (A.G.); (T.C.); (G.N.)
| | - Chiara Faggiano
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy; (A.R.); (A.G.); (C.F.)
| | - Alice Giamperoli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (A.G.); (T.C.); (G.N.)
| | - Teresa Catenaro
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (A.G.); (T.C.); (G.N.)
| | - Giulia Negrini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (A.G.); (T.C.); (G.N.)
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy; (A.R.); (A.G.); (C.F.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (A.G.); (T.C.); (G.N.)
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Raiteri A, Granito A, Giamperoli A, Catenaro T, Negrini G, Tovoli F. Current guidelines for the management of celiac disease: A systematic review with comparative analysis. World J Gastroenterol 2022; 28:154-175. [PMID: 35125825 PMCID: PMC8793016 DOI: 10.3748/wjg.v28.i1.154] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/08/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wheat and other gluten-containing grains are widely consumed, providing approximately 50% of the caloric intake in both industrialised and developing countries. The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence. This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media. However, in recent years, the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease (CD) from obscurity to global prominence. These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD. Different scientific societies, mainly from Europe and America, have proposed guidelines based on CD's most recent evidence. AIM To identify the most recent scientific guidelines on CD, aiming to find and critically analyse the main differences. METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language. PubMed was lastly accessed on 1 March 2021. RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions. Differences were noted in the possibility of a no-biopsy diagnosis, HLA testing, follow-up protocols, and procedures. CONCLUSION We found a relatively high concordance between the guidelines for CD. Important modifications have occurred in the last years, especially about the possibility of a no-biopsy diagnosis in children. Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.
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Affiliation(s)
- Alberto Raiteri
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Alice Giamperoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Teresa Catenaro
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Giulia Negrini
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
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Kozioł-Kozakowska A, Salamon D, Grzenda-Adamek Z, Krawczyk A, Duplaga M, Gosiewski T, Kowalska-Duplaga K. Changes in Diet and Anthropometric Parameters in Children and Adolescents with Celiac Disease-One Year of Follow-Up. Nutrients 2021; 13:4306. [PMID: 34959858 PMCID: PMC8703461 DOI: 10.3390/nu13124306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/15/2021] [Accepted: 11/28/2021] [Indexed: 12/12/2022] Open
Abstract
Celiac disease (CD) may cause numerous nutrient deficiencies that a proper gluten-free diet (GFD) should compensate for. The study group consists of 40 children, aged 8.43 years (SD 3.5), on average, in whom CD was diagnosed on the basis of clinical symptoms, immunological and histopathological results. The patients' height, weight, diet and biochemical tests were assessed three times: before diagnosis, after six months, and following one year of GFD. After one year, the patients' weight and height increased but nutritional status (body mass index, BMI percentile) did not change significantly. The children's diet before diagnosis was similar to that of the general Polish population: insufficient implementation of the dietary norm for energy, fiber, calcium, iodine, iron as well as folic acid, vitamins D, K, and E was observed. Over the year, the GFD of the children with CD did not change significantly for most of the above nutrients, or the changes were not significant for the overall assessment of the diet. Celiac patients following GFD may have a higher risk of iron, calcium and folate deficiencies. These results confirm the need for personalized nutritional education aimed at excluding gluten from the diet, as well as balancing the diet properly, in patients with CD.
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Affiliation(s)
- Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Institute of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Dominika Salamon
- Department of Molecular Medical Microbiology, Chair of Microbiology, Jagiellonian University Medical College, 31-121 Krakow, Poland
| | - Zofia Grzenda-Adamek
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital, 30-663 Krakow, Poland
| | - Agnieszka Krawczyk
- Department of Molecular Medical Microbiology, Chair of Microbiology, Jagiellonian University Medical College, 31-121 Krakow, Poland
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland
| | - Tomasz Gosiewski
- Department of Molecular Medical Microbiology, Chair of Microbiology, Jagiellonian University Medical College, 31-121 Krakow, Poland
| | - Kinga Kowalska-Duplaga
- Department of Pediatrics, Institute of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 30-663 Krakow, Poland
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Coto L, Mendia I, Sousa C, Bai JC, Cebolla A. Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review. World J Gastroenterol 2021; 27:6306-6321. [PMID: 34712034 PMCID: PMC8515793 DOI: 10.3748/wjg.v27.i37.6306] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/28/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gluten is a complex mixture of proteins with immunogenic peptide sequences triggering the autoimmune activity in patients with celiac disease (CeD). Gluten immunogenic peptides (GIP) are resistant to gastrointestinal digestion and are then excreted via the stool and urine. Most common detection methods applied in the follow-up visits for CeD patients such as serology tests, dietetic interviews, questionnaires, and duodenal biopsy have been proved to be inefficient, invasive, or inaccurate for evaluating gluten-free diet (GFD) compliance. Determination of excreted GIP in stool and urine has been developed as a non-invasive, direct, and specific test for GFD monitoring.
AIM To summarize published literature about the clinical utility of GIP determination in comparison to the tools employed for GFD monitoring.
METHODS PubMed and Web of Science searches were performed using the keywords “gluten immunogenic peptides” or “gluten immunogenic peptide” and a combination of the previous terms with “feces”, “stools”, “urine”, “celiac disease”, “gluten-free diet”, and “adherence” to identify relevant clinical studies published in English and Spanish between 2012 to January 2021. Reference lists from the articles were reviewed to identify additional pertinent articles. Published articles and abstracts reporting the clinical use of GIP determination in stool and/or urine for the follow-up of patients with CeD in comparison with other tools in use were included. Case reports, commentaries, reviews, conference papers, letters, and publications that did not focus on the aims of this review were excluded.
RESULTS Total of 15 publications were found that involved the use of GIP determination in stool and/or urine to monitor the adherence to the GFD in comparison to other tools. Studies included both children and adults diagnosed with CeD and healthy volunteers. Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of GFD transgressions and therefore could facilitate the follow-up of patients with CeD. Tools identified in this work included the CeD-specific serology, dietetic questionnaires, symptomatology, and the duodenal biopsy. Review of the literature revealed that the rates of GFD adherence may vary between 30%-93% using either stool or urine GIP determination, 49%-96% by the serology, 59%-94% using the dietetic questionnaires, 56%-95% by the reported symptoms and 44%-76% with the duodenal biopsy. In addition, the association between the different methods and histological abnormalities (Marsh II-III) was found to be 33%-100% for GIP determination (stool and urine), 25%-39% for CeD-specific serology, 3%-50% for dietetic questionnaires, and 22%-28% for the symptomatology.
CONCLUSION Excreted GIP detection is the precise approach for determining voluntary or involuntary gluten consumption in CeD patients preventing future complications arising from gluten exposure.
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Affiliation(s)
- Laura Coto
- Research and Development, Biomedal, Camas 41900, Seville, Spain
- Human Nutrition and Food Science Doctoral Program, University of Granada, Granada 18011, Spain
| | - Irati Mendia
- Research and Development, Biomedal, Camas 41900, Seville, Spain
- Molecular Biology, Biomedicine and Clinical Research Doctoral Program, University of Seville, Seville 41012, Spain
| | - Carolina Sousa
- Department of Microbiology and Parasitology, University of Seville, Seville 41013, Spain
| | - Julio César Bai
- Department of Gastroenterology, Dr. Carlos Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
- Research Institutes, Universidad del Salvador, Buenos Aires 1050, Argentina
| | - Angel Cebolla
- Research and Development, Biomedal, Camas 41900, Seville, Spain
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Anafy A, Cohen S, Ben Tov A, Amir A, Weintraub Y, Moran‐Lev H, Dali Levy M, Ankona Bussel M, Yerushalmy Feler A. The effect of gluten-free diet on body mass index in paediatric celiac disease. Acta Paediatr 2021; 110:2233-2239. [PMID: 33529351 DOI: 10.1111/apa.15787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
AIM More normal weight and overweight children are currently diagnosed with celiac disease (CD). We aimed to describe the relation between body mass index (BMI) and the clinical characteristics of paediatric CD and to determine the effect of a gluten-free diet (GFD) on BMI. METHODS Data on all children diagnosed with CD during 7/2010-7/2019 with documented anthropometric data at diagnosis were retrospectively analysed. The children were divided into three groups according to BMI status at diagnosis: underweight, normal weight and overweight (BMIs <5%, 5%-85% and >85%, respectively). RESULTS Of the 236 children [median age 7.87 (4.91-11) years] included in the study, 24 (10.1%) were underweight at diagnosis and 32 (13.6%) were overweight. Diarrhoea as the presenting symptom was significantly more common in the overweight group (p = 0.012), while short stature was more common in the underweight group (p = 0.002). Following a GFD had no significant effect on the children's BMI during a median follow-up of 15.7 (0-85) months, but there was a significant shift of patients between the BMI categories (p < 0.001). CONCLUSION Although a shift of patients between the BMI categories was observed, following a GFD did not significantly affect the overall BMI in children with CD.
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Affiliation(s)
- Adi Anafy
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Amir Ben Tov
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Achiya Amir
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael Weintraub
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hadar Moran‐Lev
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Margalit Dali Levy
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maayan Ankona Bussel
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Anat Yerushalmy Feler
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Ballestero-Fernández C, Varela-Moreiras G, Úbeda N, Alonso-Aperte E. Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac. Nutrients 2021; 13:1626. [PMID: 34066195 PMCID: PMC8151936 DOI: 10.3390/nu13051626] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Catalina Ballestero-Fernández
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28925 Alcorcón, Spain; (C.B.-F.); (G.V.-M.)
| | - Gregorio Varela-Moreiras
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28925 Alcorcón, Spain; (C.B.-F.); (G.V.-M.)
- Spanish Nutrition Foundation (FEN), C/General Álvarez de Castro 20, 1 pta, 28010 Madrid, Spain
| | - Natalia Úbeda
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28925 Alcorcón, Spain; (C.B.-F.); (G.V.-M.)
| | - Elena Alonso-Aperte
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28925 Alcorcón, Spain; (C.B.-F.); (G.V.-M.)
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Lojou M, Sahakian N, Dutour A, Vanbiervliet G, Bege T, Gaborit B. Celiac Disease and Obesity: Is Bariatric Surgery an Option? Obes Surg 2021; 30:2791-2799. [PMID: 32314256 DOI: 10.1007/s11695-020-04607-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Celiac disease is an immune-mediated enteropathy associated with malabsorptive syndrome and fat-soluble vitamin deficiencies. Celiac disease affects 1% of individuals but is largely underdiagnosed, as its multifaceted clinical presentations create challenging diagnostic scenarios. With the rise of the obesity epidemic, doctors are increasingly seeing celiac disease patients with overweight or obesity, which raises the question of bariatric surgery. However, few studies so far have investigated bariatric surgery in this patient population. Here, we provide a comprehensive review of the literature on celiac disease, its nutritional consequences and complications, and we discuss the possible impact of bariatric surgery on weight loss, nutritional deficiencies, response to gluten-free diet, and long-term post-operative complications. We also review the effect of bariatric surgery on the incidence of celiac disease.
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Affiliation(s)
- Manon Lojou
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Nicolas Sahakian
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Anne Dutour
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France
| | | | - Thierry Bege
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.,IFSTTAR, LBA, Aix-Marseille University, Marseille, France
| | - Bénédicte Gaborit
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France. .,INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France. .,Department of Endocrinology, Metabolic Disease and Nutrition, Pole ENDO, Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
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30
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Setavand Z, Ekramzadeh M, Honar N. Evaluation of malnutrition status and clinical indications in children with celiac disease: a cross-sectional study. BMC Pediatr 2021; 21:147. [PMID: 33781226 PMCID: PMC8006373 DOI: 10.1186/s12887-021-02621-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Celiac Disease (CD) is an autoimmune systemic disorder triggered by gluten in genetically susceptible individuals, which can lead to chronic malabsorption. Considering the changes in the manifestations of CD, this study aimed to determine anthropometric indices and clinical indications in children with CD. METHODS This cross-sectional study aimed to evaluate the children with CD who had referred to Imam Reza Celiac Clinic between 2016 and 2019. Totally, 361 children were eligible and their anti-tissue transglutaminase (TGA-IgA) level, weight, height, and Body Mass Index (BMI) were extracted from their records. The anthropometric indices were presented based on the criteria of the Center for Disease Control and Prevention (CDC) and World Health Organization (WHO). The prevalent symptoms were assessed, as well. RESULTS Based on the CDC's criteria, 18.3, 28.8, and 25.8% of the children had short stature, low body weight, and low BMI, respectively. These measures were obtained as 10, 22.4, and 13.9% according to the WHO's categorization respectively. Furthermore, the most common symptoms among the children were abdominal pain (56.5%), skeletal pain (28%), constipation (27.4%), and anemia (23.8%). CONCLUSION To sum up, the results clearly indicated that growth failure and low height, weight, and BMI were prevalent among the children with CD. Moreover, in addition to gastrointestinal symptoms, a considerable number of patients had skeletal pain and anemia.
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Affiliation(s)
- Zahra Setavand
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Naser Honar
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Tarar ZI, Zafar MU, Farooq U, Basar O, Tahan V, Daglilar E. The Progression of Celiac Disease, Diagnostic Modalities, and Treatment Options. J Investig Med High Impact Case Rep 2021; 9:23247096211053702. [PMID: 34693776 PMCID: PMC8767653 DOI: 10.1177/23247096211053702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023] Open
Abstract
Celiac disease (CD) is an autoimmune disorder that affects genetically predisposed individuals who are sensitive to gluten and related proteins. It affects children and adults with increasing prevalence in the older age groups. Both adaptive and innate immune responses play role in CD pathogenesis which results in damage of lamina propria and deposition of intraepithelial lymphocytes. There are other proposed mechanisms of CD pathogenesis like gastrointestinal infections, intestinal microbiota, and early introduction of gluten. The diagnosis of CD is based on clinical symptoms and serological testing, though a majority of cases are asymptomatic, and small intestinal biopsies are required to confirm the diagnosis. Celiac disease is generally associated with other autoimmune diseases, and it is advisable to test these patients for diseases like type 1 diabetes mellitus, Addison's disease, thyroid diseases, inflammatory bowel disease, and autoimmune hepatitis. The patient with a new diagnosis of CD requires close follow-up after starting treatment to see symptom improvement and check dietary compliance. A newly diagnosed patient is advised to follow with a dietitian to better understand the dietary restrictions as about 20% of patients stay symptomatic even after starting treatment due to noncompliance or poor understanding of diet restrictions. The most effective treatment for CD is a gluten-free diet, but work on non-dietary therapy is in process and few medications are in the clinical trial phase.
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Affiliation(s)
| | | | - Umer Farooq
- Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
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32
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Agarwal A, Singh A, Mehtab W, Gupta V, Chauhan A, Rajput MS, Singh N, Ahuja V, Makharia GK. Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver. Intest Res 2021; 19:106-114. [PMID: 32312034 PMCID: PMC7873403 DOI: 10.5217/ir.2019.00136] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/30/2019] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease. METHODS Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan. RESULTS In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively. CONCLUSIONS Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.
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Affiliation(s)
- Ashish Agarwal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Wajiha Mehtab
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vipin Gupta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Chauhan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mahendra Singh Rajput
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Govind K. Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Sukkar G, Alshareef AM, Aljahani M, Alharthi HA, Fakieha A. The Prevalence of Growth Variations Among Pediatric Celiac Disease Patients at the Time of Diagnosis. Cureus 2020; 12:e11706. [PMID: 33391939 PMCID: PMC7769797 DOI: 10.7759/cureus.11706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and aim Celiac disease is an immune-mediated disorder caused by sensitivity to dietary gluten. Celiac patients typically present with malabsorption and low growth parameters; however, studies have shown that the presentation of celiac disease can have a higher percentage of patients with normal or high growth parameters and no signs of malabsorption. The study aims to estimate the prevalence of the growth variation found in children with biopsy-confirmed celiac disease at the time of diagnosis. Methods We included 31 biopsy-confirmed pediatric celiac patients diagnosed from 2007 to 2018 in King Abdulaziz Medical City, Jeddah, Saudi Arabia. Patients’ height, weight, and BMI at the time of diagnosis were converted to z-scores and growth percentiles according to the Centers for Disease Control and Prevention growth charts. In addition, patients’ comorbid conditions were also recorded. Results At the time of diagnosis, 45.16% of our patients presented as underweight, 41.94% of patients had normal weight, 6.5% were overweight and obese, respectively. The mean BMI was 15.44 (±3.65). Our population had a statistically significant lower BMI, height, and weight mean z-scores at the time of diagnosis. Conclusion A significant number of children diagnosed with celiac disease in our center had low weight, height, and BMI at the time of diagnosis. However, we emphasize that having normal growth parameters does not rule out the diagnosis of celiac disease.
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A Narrow Window: Booming Gluten-free Market and Fostering Healthy Dietary Habits in Children With Celiac Disease. J Pediatr Gastroenterol Nutr 2020; 71:533-535. [PMID: 32960543 DOI: 10.1097/mpg.0000000000002831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
An expanding gluten-free marketplace has left children with celiac disease and their families with a host of new dietary options. The quality of these foods is inconsistent and processed items may be high in caloric content while lacking nutritional value. Assessing the dietary preferences of a cohort of children with celiac disease via cross-sectional survey, we find that these processed food items have become a staple of the gluten-free diet, and in many cases, these foods are consumed to the exclusion of healthy alternatives. Furthermore, children with celiac disease and their families become less interested in dietary education over time, indicating that the greatest opportunity for imparting a healthy diet may occur at the time of diagnosis.
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35
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Medina Carbonell FR, Choyudhry Chandan O. Body Mass Index at Presentation of Inflammatory Bowel Disease in Children. Pediatr Gastroenterol Hepatol Nutr 2020; 23:439-446. [PMID: 32953639 PMCID: PMC7481061 DOI: 10.5223/pghn.2020.23.5.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The evidence for an association between inflammatory bowel disease (IBD) and obesity is conflicting. Therefore, we set out to review the body mass index (BMI) at presentation of IBD to understand if the rise of the obesity rate in the general population, lead to an increase of obesity in patients with IBD at the time of diagnosis. METHODS Retrospective review of all patients with IBD seen at Children's Hospital and Medical Center from January 1st 2010 to December 31st 2014. From the initial visit and endoscopy, we obtained: age; sex; BMI; disease phenotype; disease severity. RESULTS We had a total of 95 patients, 35 patients were excluded due to incomplete data or referral being made after diagnosis was made. 28 were males and 32 were females, Age range was 2-17 years. A 37 had Crohn's disease, 19 ulcerative colitis, and 4 indeterminate colitis. Disease severity in 19 cases was mild, 29 moderate and 12 severe. BMI distribution was as follows-obese (5.0%), overweight (6.7%), normal weight (65.0%), mild malnutrition (8.3%), moderate malnutrition (15.0%), severe malnutrition (1.7%). CONCLUSION Our data is consistent with other series. Showing most children had a normal BMI, regardless of disease severity or phenotypes. One confounding factor is the possibility of delay in referral to GI. This could mean some obese children may fall in the normal BMI range at the time of diagnosis due to ongoing weight loss. Future studies should include prospective cohort studies, comparing incidence of IBD in obese and non-obese patients, severity at presentation, duration of symptoms, and clinical outcomes.
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Affiliation(s)
- Fernando R Medina Carbonell
- Department of Pediatrics, Division of Gastroenterology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ojasvini Choyudhry Chandan
- Department of Pediatrics, Division of Gastroenterology, University of Nebraska Medical Center, Omaha, NE, USA
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Arabi A, Karrar ZA, Mubarak FH, Bilal JA. Clinical presentation of coeliac disease and the effect of sorghum-based diet on anthropometric measurements among Sudanese children. Sudan J Paediatr 2020; 20:144-151. [PMID: 32817735 DOI: 10.24911/sjp.106-1586348889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coeliac disease (CD) is a chronic enteropathy. Sorghum (Sorghum vulgaris) is a common staple in Sudan. The literature on the growth of children with CD following sorghum diet is scanty. The aim of this study was to identify the demographic and clinical characteristics of CD in children and to determine the anthropometric response to a diet based on sorghum. This prospective study included children with probable CD in Ibn Sina Hospital, Khartoum, Sudan, from January 2002 to February 2012. The demographic, anthropometric, clinical and laboratory data were recorded. The CD serology was done, and the diagnosis of CD was based on Marsh criteria. Children who consumed sorghum and their anthropometry were recorded at 3 and 6 months after diagnosis. Children enrolled were 218. The mean ± SD age was 8.2 ± 4.5, median was 7 years and female/male ratio was 1.12/1. CD was common among Nubians and Arabs. The majority (145, 66.5%) presented with gastrointestinal symptoms. Feeding on sorghum diet resulted in a significant increase in weight after 3 and 6 months (21.1 ± 9.8 and 25.1 ± 14.2 kg, respectively) of the initial visit (18.5 ± 9.4 kg), p < 0.001 and p = 0.001, respectively. The mean weight for height had significantly increased at the second compared to the initial visit (0.17 ± 0.05 vs. 0.15 ± 0.5), p < 0.001. There was no association between gaining weight and age, gender, or a family history of CD. In conclusion, Sudanese children with CD presented over 8 years of age. The common presentation was gastrointestinal symptoms. The initial weight and weight-for-height increment were significant on sorghum diet.
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Affiliation(s)
- Ali Arabi
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Zein A Karrar
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Jalal Ali Bilal
- Pediatrics Department, College of Medicine, Shaqra University, Saudi Arabia
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Cheng FW, Handu D. Nutrition Assessment, Interventions, and Monitoring for Patients with Celiac Disease: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 120:1381-1406. [PMID: 31953154 DOI: 10.1016/j.jand.2019.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Indexed: 11/21/2022]
Abstract
The objectives of this scoping review were to identify and characterize studies examining nutrition assessment, interventions, and measures to monitor gluten-free diet (GFD) adherence/compliance in patients with celiac disease (CD). An electronic literature search of four databases (Cochrane Database for systematic reviews, CINAHL, Embase, and Ovid MEDLINE) was conducted to identify articles examining nutrition care in CD individuals. Except for narrative review, grey literature, and case study/report, all types of peer-reviewed articles published between January 2007 and August 2018 were eligible. There were a total of 10,823 records; 10,368 were excluded during the first round of screening due to irrelevancy and/or duplication. Of the 455 full-text articles that were assessed, 292 met the criteria and were included. Most of the studies were observational studies (n=212), followed by experimental trials (n=50), evidence-based practice guideline (EBPG)/report/statement (n=16), and systematic review (SR) (n=14). Nine original studies examined assessment, focusing mainly on different tools/ways to assess GFD adherence. The majority of the included original articles (n=235) were in the nutrition intervention category with GFD, oats, and prebiotics/probiotics as the top-three most studied interventions. There were eight SRs on GFD and five on oats. One SR and 21 original studies investigated the effectiveness of different measures to monitor GFD adherence/compliance. Although recent CD EBPGs were identified, different methods with varying levels of rigor, in terms of literature search and assessment of evidence strength, were used. Based on this scoping review, interventions focused on gluten-free diet and oats have been significantly covered by either SRs or EBPGs. Studies related to prebiotics/probiotics and education program/counseling focused interventions, as well as assessment, in CD patients have increased in recent years. Thus, it might be beneficial to conduct SRs/EBPGs focused on these topics to guide practitioners.
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Calcaterra V, Regalbuto C, Manuelli M, Klersy C, Pelizzo G, Albertini R, Vinci F, Larizza D, Leonard MM, Cena H. Screening for celiac disease among children with overweight and obesity: toward exploring celiac iceberg. J Pediatr Endocrinol Metab 2020; 33:/j/jpem.ahead-of-print/jpem-2020-0076/jpem-2020-0076.xml. [PMID: 32653877 DOI: 10.1515/jpem-2020-0076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022]
Abstract
Background The coexistence of celiac disease (CD) and obesity/overweight is not unusual. Objective We investigate the prevalence and clinical presentation of CD, detected by screening, among children with excessive weight gain. Methods We enrolled 200 children referred for overweight/obesity to our outpatient clinic. Medical history during pregnancy and childhood and lifestyle variables were recorded. Patients were screened for CD with total immunoglobulin A (IgA), IgA anti-transglutaminase (tTG-IgA) and IgA anti-endomysial antibodies (EMA-IgA). In subjects with positive autoantibodies, esophagogastroduodenoscopy (EGDS) was performed and genetic testing for HLA DQ2 and/or DQ8 haplotypes was tested. Results CD positive antibodies (tTg-IgA and EMA-IgA) were detected in eight patients (4%); in all subjects CD diagnosis was confirmed by HLA-DQ2 and/or DQ8 compatibility and EGDS. No association between CD and medical history during pregnancy and childhood or lifestyle variables was noted; however, a dietary difference was identified with those testing positive for CD also reporting a lower weekly consumption of fruits and vegetables (p=0.04). Headache was reported more frequently in patients with than without CD (p=0.04). Familiar positivity for autoimmune diseases was revealed in CD patients (p=0.01). Conclusion CD should be considered in children with excessive weight gain. Familial predisposition to other autoimmune diseases may represent a risk factor for development of CD. Even though the relationship between headache and CD is not well defined, the patients with headache of unknown origin should be screened for CD.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Surgery Unit, Children's Hospital "Vittore Buzzi", Milano, Italy
| | - Corrado Regalbuto
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinologic Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Manuelli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, Children's Hospital "Vittore Buzzi", Milano, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Vinci
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinologic Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Larizza
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinologic Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maureen M Leonard
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, Massachusetts, USA
- Division of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
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The Gluten Free Diet's Impact on Growth in Children with Celiac Disease in Two Different Countries. Nutrients 2020; 12:nu12061547. [PMID: 32466557 PMCID: PMC7352316 DOI: 10.3390/nu12061547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/12/2023] Open
Abstract
The effects of gluten free diet (GFD) on body mass index (BMI) and growth parameters in pediatric patients with celiac disease (CD) and their dependence on different socio-cultural environments are poorly known. We conducted an international retrospective study on celiac patients diagnosed at the University of Verona, Italy, and at the University of Chicago, Chicago, IL, USA, as underweight. A total of 140 celiac children and 140 controls (mean age 8.4 years) were enrolled in Chicago; 125 celiac children and 125 controls (mean age 7.3 years, NS) in Verona. At time of diagnosis, Italian celiac children had a weight slightly lower (p = 0.060) and a BMI z-score significantly (p < 0.001) lower than their American counterparts. On GFD, Italian celiac children showed an increased prevalence of both underweight (19%) as well as overweight (9%), while American children showed a decrease prevalence of overweight/obese. We concluded that while the GFD had a similar impact on growth of celiac children in both countries, the BMI z-score rose more in American than in Italian celiac children. Additionally, in Italy, there was an alarming increase in the proportion of celiac children becoming underweight. We speculate that lifestyle and cultural differences may explain the observed variations.
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Myléus A, Reilly NR, Green PHR. Rate, Risk Factors, and Outcomes of Nonadherence in Pediatric Patients With Celiac Disease: A Systematic Review. Clin Gastroenterol Hepatol 2020; 18:562-573. [PMID: 31173891 DOI: 10.1016/j.cgh.2019.05.046] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The only treatment for celiac disease is strict adherence to a gluten-free diet (GFD). We performed a systematic review to investigate the rate of adherence to a GFD in children with celiac disease, risk factors that affect adherence, and outcomes of non-adherence. METHODS We searched PubMed, Cochrane Library, EBSCO, and Scopus for studies through January 2019. We included observational studies of ≥50 children diagnosed with celiac disease and recommended for placement on a GFD. We collected data on adherence assessment (self-report, serology tests, structured dietary interview, biopsies, or assays for gluten immunogenic peptides), risk factors, and outcomes related to adherence. Findings were presented with medians, range, and a narrative synthesis. RESULTS We identified 703 studies; of these, 167 were eligible for full-text assessment and 49 were included in the final analysis, comprising 7850 children. Rates of adherence to a GFD ranged from 23% to 98%. Comparable rates (median rates of adherence, 75%-87%) were found irrespective of how assessments were performed. Adolescents were at risk of non-adherence and children whose parents had good knowledge about celiac disease adhered more strictly. Non-adherence associated with patient growth, symptoms, and quality of life. CONCLUSION In a systematic review of 49 studies of children with celiac disease, we found substantial variation in adherence to a GFD among patients. Rate of adherence was not associated with method of adherence measurement, so all methods appear to be useful, with lack of consensus on the ideal metric. Studies are needed to determine the best method to ensure adherence and effects on long-term health.
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Affiliation(s)
- Anna Myléus
- Division of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Norelle R Reilly
- Department of Pediatrics, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York
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McAllister BP, Williams E, Clarke K. A Comprehensive Review of Celiac Disease/Gluten-Sensitive Enteropathies. Clin Rev Allergy Immunol 2020; 57:226-243. [PMID: 29858750 DOI: 10.1007/s12016-018-8691-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Celiac disease is a complex immune-mediated gluten-sensitive enteropathy with protean clinical manifestations. It is manifest in genetically predisposed individuals who ingest gluten in varying amounts. In broad terms, it is thought to affect 1% of the population in the USA. More specifically, the prevalence increases drastically from 1:133 in patients not-at-risk, to 1:56 in symptomatic patients, to 1:39 in patients with a second-degree relative with the diagnosis, and to 1:22 in patients with a first-degree relative with the diagnosis. It may be associated with several immune-mediated phenomena, autoimmune diseases, and complicated by vitamin and other trace element deficiencies, bone disease, and malignancy. Our understanding of celiac disease has evolved rapidly over the past two decades. This has led to several lines of enquiry on the condition and potential treatment options. More recently, several entities including gluten intolerance, non-celiac gluten sensitivity, and seronegative celiac disease have been described. These conditions are distinct from allergies or intolerance to wheat or wheat products. There are challenges in defining some of these entities since a large number of patients self-report these conditions. The absence of confirmatory diagnostic tests poses an added dilemma in distinguishing these entities. The differences in spectrum of symptoms and highlights of the variability between the pediatric and adult populations have been studied in some detail. The role of screening for celiac disease is examined in both the general population and "at risk" populations. Diagnostic strategies including the best available serologic testing, utility of HLA haplotypes DQ2 and DQ8 which are seen in over 90% of patients with celiac disease as compared with approximately 40% of the general population, and endoscopic evaluation are also reviewed. Comprehensive nutritional management after diagnosis is key to sustained health in patients with celiac disease. Simple algorithms for care based on a comprehensive multidisciplinary approach are proposed. Refractory and non-responsive celiac diseases in the setting of a gluten-free diet are examined as are novel non-dietary therapies. Finally, the association of other disease states including psychiatric illness, infertility, lymphoproliferative malignancy, and mortality is explored with special attention paid to autoimmune and atopic disease.
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Affiliation(s)
- Brian P McAllister
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Mail Code HU33, 500 University Drive, UPC Suite 2400, Hershey, PA, 17033-0850, USA
| | - Emmanuelle Williams
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Mail Code HU33, 500 University Drive, UPC Suite 2400, Hershey, PA, 17033-0850, USA
| | - Kofi Clarke
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Mail Code HU33, 500 University Drive, UPC Suite 2400, Hershey, PA, 17033-0850, USA.
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Villanueva M, Oyarzún A, Leyton B, González M, Navarro E, Canales P, Ossa C, Muñoz MP, Bascuñán KA, Araya M. Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades. Nutrients 2020; 12:nu12010156. [PMID: 31935859 PMCID: PMC7019995 DOI: 10.3390/nu12010156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/13/2022] Open
Abstract
The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.
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Affiliation(s)
- Mónica Villanueva
- Fellow, Pediatric Gastroenterology and Nutrition Program, Faculty of Medicine, University of Chile, Santiago, Chile, Clínica Alemana de Santiago, Chile;
| | - Amaya Oyarzún
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile; (A.O.); (B.L.); (K.A.B.)
| | - Bárbara Leyton
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile; (A.O.); (B.L.); (K.A.B.)
| | | | | | - Paulina Canales
- Hospital Exequiel González Cortés, Santiago, Chile; (E.N.); (P.C.)
| | - Cristobal Ossa
- Hospital Luis Calvo Mackenna, Santiago, Chile; (C.O.); (M.P.M.)
| | - María Paz Muñoz
- Hospital Luis Calvo Mackenna, Santiago, Chile; (C.O.); (M.P.M.)
| | - Karla A. Bascuñán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile; (A.O.); (B.L.); (K.A.B.)
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Magdalena Araya
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile; (A.O.); (B.L.); (K.A.B.)
- Correspondence:
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Ballestero Fernández C, Varela-Moreiras G, Úbeda N, Alonso-Aperte E. Nutritional Status in Spanish Children and Adolescents with Celiac Disease on a Gluten Free Diet Compared to Non-Celiac Disease Controls. Nutrients 2019; 11:E2329. [PMID: 31581546 PMCID: PMC6835854 DOI: 10.3390/nu11102329] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
Patients who follow a gluten-free diet (GFD) may be prone to nutritional deficiencies, due to food restriction and consumption of gluten-free products. The aim was to assess nutritional status in celiac children and adolescents on a long-term GFD. A cross-sectional age and gender-matched study in 70 celiac and 67 non-celiac volunteers was conducted, using dietary, anthropometric, biochemical parameters, and assessing bone mineral density and physical activity. Adequacy of vitamin D intake to recommendations was very low, in both groups, and intakes for calcium and magnesium were significantly lower in celiac volunteers. Celiac children and adolescents may have a higher risk of iron and folate deficiencies. Both groups followed a high-lipid, high-protein, low fiber diet. Median vitamin D plasma levels fell below reference values, in celiac and non-celiac participants, and were significantly lower in celiac girls. Other biochemical parameters were within normal ranges. Anthropometry and bone mineral density were similar within groups. With the exception of some slightly lower intakes, children and adolescents following a GFD appear to follow the same trends as healthy individuals on a normal diet. No effect of food restriction or gluten-free product consumption was observed.
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Affiliation(s)
- Catalina Ballestero Fernández
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia. Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain.
| | - Gregorio Varela-Moreiras
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia. Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain.
| | - Natalia Úbeda
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia. Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain.
| | - Elena Alonso-Aperte
- Department of Pharmaceutical and Health Sciences, Facultad de Farmacia. Universidad San Pablo-CEU, CEU Universities, 28668 Madrid, Spain.
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Anthropometric Parameters in Celiac Disease: A Review on the Different Evaluation Methods and Disease Effects. J Nutr Metab 2019; 2019:4586963. [PMID: 31583132 PMCID: PMC6754920 DOI: 10.1155/2019/4586963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/03/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
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.
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Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, Fasano A. Celiac disease: a comprehensive current review. BMC Med 2019; 17:142. [PMID: 31331324 PMCID: PMC6647104 DOI: 10.1186/s12916-019-1380-z] [Citation(s) in RCA: 550] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Celiac disease remains a challenging condition because of a steady increase in knowledge tackling its pathophysiology, diagnosis, management, and possible therapeutic options. MAIN BODY A major milestone in the history of celiac disease was the identification of tissue transglutaminase as the autoantigen, thereby confirming the autoimmune nature of this disorder. A genetic background (HLA-DQ2/DQ8 positivity and non-HLA genes) is a mandatory determinant of the development of the disease, which occurs with the contribution of environmental factors (e.g., viral infections and dysbiosis of gut microbiota). Its prevalence in the general population is of approximately 1%, with female predominance. The disease can occur at any age, with a variety of symptoms/manifestations. This multifaceted clinical presentation leads to several phenotypes, i.e., gastrointestinal, extraintestinal, subclinical, potential, seronegative, non-responsive, and refractory. Although small intestinal biopsy remains the diagnostic 'gold standard', highly sensitive and specific serological tests, such as tissue transglutaminase, endomysial and deamidated gliadin peptide antibodies, have become gradually more important in the diagnostic work-up of celiac disease. Currently, the only treatment for celiac disease is a life-long, strict gluten-free diet leading to improvement in quality of life, ameliorating symptoms, and preventing the occurrence of refractory celiac disease, ulcerative jejunoileitis, and small intestinal adenocarcinoma and lymphoma. CONCLUSIONS The present review is timely and provides a thorough appraisal of various aspects characterizing celiac disease. Remaining challenges include obtaining a better understanding of still-unclear phenotypes such as slow-responsive, potential (minimal lesions) and seronegative celiac disease. The identification of alternative or complementary treatments to the gluten-free diet brings hope for patients unavoidably burdened by diet restrictions.
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Affiliation(s)
- Giacomo Caio
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Anna Sapone
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
- Takeda Pharmaceuticals International Co, Cambridge, MA 02139 USA
| | - Daniel A. Leffler
- Takeda Pharmaceuticals International Co, Cambridge, MA 02139 USA
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02115 USA
| | - Roberto De Giorgio
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
| | - Carlo Catassi
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
- Department of Pediatrics, Center for Celiac Research, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Alessio Fasano
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
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46
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Di Nardo G, Villa MP, Conti L, Ranucci G, Pacchiarotti C, Principessa L, Raucci U, Parisi P. Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review. Nutrients 2019; 11:1588. [PMID: 31337023 PMCID: PMC6683263 DOI: 10.3390/nu11071588] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/04/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A strictly gluten-free diet (GFD) is the basis for managing celiac disease (CD). Numerous studies have reported nutritional deficiencies/imbalances ascribable to a GFD. The aim of this review is to describe nutritional deficiencies observed in children with celiac disease on a GFD, to discuss the clinical consequences related to these nutritional imbalances, and to identify strategies that may be adopted to treat them. METHODS We reviewed the MEDLINE and EMBASE databases between January 1998 and January 2019. RESULTS Children are, regardless of whether they are on a gluten-free diet or not, at risk of consuming too much fat and insufficient fiber, iron, vitamin D, and calcium. These imbalances may be exacerbated when children are on a gluten-free diet. In particular, the intake of folate, magnesium, zinc, and foods with a high glycemic index in children with CD who are on a GFD is significantly altered. CONCLUSIONS Therapeutic protocols should include nutritional education to help teach subjects affected by disorders such as CD the importance of labels, the choice of foods, and the combination of macro- and micronutrients. Children with CD on a GFD should be encouraged to rotate pseudo-cereals, consume gluten-free commercial products that have been fortified or enriched, and use foods that are local and naturally gluten-free.
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Affiliation(s)
- Giovanni Di Nardo
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Laura Conti
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Giusy Ranucci
- Pediatric Unit, AORN Santobono-Pausilipon, 80129 Naples, Italy
| | - Claudia Pacchiarotti
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Luigi Principessa
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy.
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Bittker SS, Bell KR. Potential risk factors for celiac disease in childhood: a case-control epidemiological survey. Clin Exp Gastroenterol 2019; 12:303-319. [PMID: 31308721 PMCID: PMC6615019 DOI: 10.2147/ceg.s210060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Celiac disease (CD) prevalence has increased significantly in recent decades in some developed countries. Yet the environmental factors in the existing literature do not appear to provide a satisfactory explanation for this increase. Objective: To determine whether nine variables are associated with CD in children. These variables are: incidence of ear infection before 2 years old, courses of antibiotics before 2 years old, duration of breastfeeding, vitamin D drop exposure in infancy, vitamin D supplement exposure between 2–3 years old, age at gluten introduction into the diet, fat content of cow’s milk consumed between 2–3 years old, quantity of cow’s milk consumed between 2–3 years old, and type of water consumed at 2 years old. Methods: An Internet-based survey was conducted among parents living in the US with at least one biological child between 3 and 12 years old. Potential participants were informed about the survey through social media, websites, electronic newsletters, and advertisements. Results: After exclusions, there remained 332 responses associated with children with CD (cases), and 241 responses associated with children who do not have CD (controls). In this data set, skim milk as the primary form of liquid cow’s milk consumed between 2–3 years old (adjusted odds ratio [aOR]=3.556, CI=1.430–10.22, P=0.010), vitamin D drops administered for more than 3 months (aOR=1.749, CI=1.079–2.872, P=0.025), courses of antibiotics (aOR=1.133, CI=1.037–1.244, P=0.007), and incidence of ear infection (aOR=1.183, CI=1.041–1.348, P=0.010) are all associated with CD in children. Conclusions: This study is the first to find an association between skim milk consumption and CD and vitamin D drop use for greater than 3 months and CD. It also adds to evidence that early life exposure to antibiotics and early life infection, specifically ear infection, are associated with CD. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/y9aThwSZHoE
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Affiliation(s)
- Seth Scott Bittker
- Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York, New York, US
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Calcaterra V, Regalbuto C, Madè A, Magistrali M, Leonard MM, Cena H. Coexistence of Excessive Weight Gain and Celiac Disease in Children: An Unusual Familial Condition. Pediatr Gastroenterol Hepatol Nutr 2019; 22:407-412. [PMID: 31338317 PMCID: PMC6629591 DOI: 10.5223/pghn.2019.22.4.407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 12/27/2022] Open
Abstract
Excessive weight gain in children diagnosed with celiac disease (CD) is becoming more common. We describe 2 siblings (9-year and 6 months-old female and 6-year and 9 months-old male) with obesity showing attenuated gastrointestinal and atypical symptoms in which CD was diagnosed in the absence of a known family history of CD. After children's diagnosis, CD in their parents was also investigated. It was detected in their father affected by overweight. The presentation of patients with CD has changed. While patients with overweight and obesity commonly have symptoms such as abdominal pain, reflux, headache, and constipation due to lifestyle factors, CD should also be considered in patients with or without a family history of CD. Careful nutritional status assessment and follow-up monitoring after the diagnosis of CD are mandatory, especially in subjects who are already overweight at the presentation of this disease.
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Affiliation(s)
- Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Corrado Regalbuto
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alexandra Madè
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariasole Magistrali
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maureen M Leonard
- Mass General Hospital for Children, Harvard Medical School, Boston, MA, United States.,Division of Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, MA, United States.,Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, United States of America Celiac Research Program, Harvard Medical School, Boston, MA, United States
| | - Hellas Cena
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy.,Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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49
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Mansueto P, Soresi M, La Blasca F, Fayer F, D'Alcamo A, Carroccio A. Body Mass Index and Associated Clinical Variables in Patients with Non-Celiac Wheat Sensitivity. Nutrients 2019; 11:1220. [PMID: 31146428 PMCID: PMC6627298 DOI: 10.3390/nu11061220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-Celiac Wheat Sensitivity (NCWS) is still a largely undefined condition, due to the lack of a diagnostic marker. Few data are available about the nutritional characteristics of NCWS patients at diagnosis. AIMS To evaluate the proportion of NCWS patients who were underweight, normal weight, overweight, or obese at diagnosis, and to search for possible correlations between their Body Mass Index (BMI) and other NCWS-related disease characteristics. PATIENTS AND METHODS The clinical charts of 145 NCWS patients (125 F, 20 M, mean age 37.1 ± 11.4 years), diagnosed between January 2012 and March 2018, were reviewed. As a comparison, 84 celiac disease (CD) patients (73 F, 11 M, mean age 39.8 ± 13.9 years) were evaluated. All NCWS diagnoses were based on a double-blind placebo-controlled wheat challenge (DBPCWC) method. RESULTS BMI distribution was similar in the NCWS (6.2% underweight and 15.2% obese subjects) and CD patients (6% underweight and 7.1% obese subjects). Underweight NCWS subjects were significantly younger and had a shorter clinical history than the overweight or obese ones. Unlike the other NCWS patients, none of them had a DQ2 and/or DQ8 haplotype. Overweight and obese NCWS patients were more frequently suffering from associated autoimmune diseases than the other BMI categories (P = 0.05). Compared to the CD controls, NCWS patients showed a higher frequency of Irritable Bowel Syndrome (IBS)-like (P = 0.01) and extraintestinal symptoms (P = 0.03) and a longer clinical history (P = 0.04), whereas weight loss was more frequent in CD (P = 0.02). CONCLUSIONS NCWS patients showed a BMI distribution similar to CD patients. However, NCWS was found to be a heterogenous condition that regards BMI, and clinical characteristics differed between the underweight and overweight/obese patients.
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Affiliation(s)
- Pasquale Mansueto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90129 Palermo, Italy.
| | - Maurizio Soresi
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90129 Palermo, Italy.
| | - Francesco La Blasca
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90129 Palermo, Italy.
| | - Francesca Fayer
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90129 Palermo, Italy.
| | - Alberto D'Alcamo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90129 Palermo, Italy.
| | - Antonio Carroccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, and Internal Medicine, Giovanni Paolo II Hospital, 92019 Sciacca (ASP Agrigento), Italy.
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The Effect of Gluten-free Diet on Cardiovascular Risk Factors in Newly Diagnosed Pediatric Celiac Disease Patients. J Pediatr Gastroenterol Nutr 2019; 68:684-688. [PMID: 30562306 DOI: 10.1097/mpg.0000000000002235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although gluten-free diet (GFD) is the only proven therapy for celiac disease (CD), its effect on cardiovascular disease (CVD) risk factors is still unclear. Our aim was to determine whether adherence to GFD affects CVD risk factors among newly diagnosed pediatric CD subjects. METHODS We prospectively enrolled pediatric subjects undergoing upper gastrointestinal endoscopy for suspected CD. We collected anthropometric and laboratory parameters related to CVD risk factors at the time of CD diagnosis and 1 year after initiation of a GFD and evaluated changes in CVD risk factors. Paired t tests or Wilcoxon nonparametric tests were used, each when appropriate. RESULTS One hundred ten newly diagnosed CD pediatric subjects were included in the analysis. There were 64 (58.2%) girls and the mean age at diagnosis was 6.8 ± 3.4 years. Median body mass index z scores (P = 0.84), rates of underweight or overweight (P = 0.32), and rates of elevated blood pressure (P = 0.78) remained unchanged. Although median fasting insulin levels increased (1.9 vs 5.4 μU/mL, P < 0.001), insulin resistance as measured by homeostatic model assessment did not increase after 1 year of GFD (P = 0.16). Although rates of dyslipidemia remained unchanged, median high-density lipoprotein levels increased on GFD (47 vs 51 mg/dL, P < 0.001). CONCLUSIONS In this pediatric CD cohort, GFD for 1 year was not associated with increased CVD risk factors. The long-term significance of these mild changes is yet to be determined.
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