Gluten-free diet intervention reduces thiamine intake in two weeks increases glycaemic response and body weight in four weeks, with no long term nutritional deficiencies

Abstract Background The only available treatment for celiac disease (CD) is adherence to a strict gluten-free diet (GFD). CD is associated with several nutritional deficiencies, which could be explained by malabsorption when the disease is active. However, the magnitude of nutritional deficiencies in treated CD and how this is influenced by the duration and compliance of GFD is less clear. Aims We aim to evaluate the presence of nutritional deficiencies in celiac patients on short term (≤2yrs) vs long-term (>2yrs) GFD, and in those with persistent symptoms or asymptomatic in the follow up. Methods We included consecutive biopsy-proven CD patients attending the McMaster Adult Celiac Clinic. GFD adherence was assessed by validated Celiac Dietary Adherence Test (CDAT) and by anti-tissue transglutaminase antibody IgA(tTG IgA) levels. Serology, vitamins and minerals were measured in blood samples collected at enrolment. Continuous data was expressed as Median (IQR) and categorical data as proportion%. Mann-U-Whitney and Chi2 were used to compare difference between groups. Results We enrolled 171 CD patients (80% female; Median age 43 years). 76/171 (44%) of CD patients were following a GFD for over 2 years. Eighty-two percent of the patients (141/171) had persistent symptoms in the follow up and 80.7% had normal tTG IgA levels. The most common nutritional abnormalities were deficiencies in zinc (56%), iron (23%), copper (20%). Chromium was increased in 74% of patients. There were no differences in nutritional deficiencies between group of patients with short and long-term duration of GFD, nor between those strictly compliant with GFD compared to those fairly compliant (p>0.05). Conclusions Nutritional deficiencies are frequent in celiac patients on a GFD regardless of the presence of symptoms, dietary compliance or duration. The previous suggest that nutrients deficiencies may be more related to GFD nutritional inadequacy rather than malabsorption. Funding Agencies None

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Rationale for Timing of Follow-Up Visits to Assess Gluten-Free Diet in Celiac Disease Patients Based on Data Mining

Nutrients ◽

10.3390/nu13020357 ◽

2021 ◽

Vol 13 (2) ◽

pp. 357

Author(s):

Alfonso Rodríguez-Herrera ◽

Joaquín Reyes-Andrade ◽

Cristina Rubio-Escudero

Keyword(s):

Data Mining ◽

Celiac Disease ◽

Cultural Context ◽

Gluten Free Diet ◽

Gluten Free ◽

Adherence To Diet ◽

And Gender ◽

Few Data

The assessment of compliance of gluten-free diet (GFD) is a keystone in the supervision of celiac disease (CD) patients. Few data are available documenting evidence-based follow-up frequency for CD patients. In this work we aim at creating a criterion for timing of clinical follow-up for CD patients using data mining. We have applied data mining to a dataset with 188 CD patients on GFD (75% of them are children below 14 years old), evaluating the presence of gluten immunogenic peptides (GIP) in stools as an adherence to diet marker. The variables considered are gender, age, years following GFD and adherence to the GFD by fecal GIP. The results identify patients on GFD for more than two years (41.5% of the patients) as more prone to poor compliance and so needing more frequent follow-up than patients with less than 2 years on GFD. This is against the usual clinical practice of following less patients on long term GFD, as they are supposed to perform better. Our results support different timing follow-up frequency taking into consideration the number of years on GFD, age and gender. Patients on long term GFD should have a more frequent monitoring as they show a higher level of gluten exposure. A gender perspective should also be considered as non-compliance is partially linked to gender in our results: Males tend to get more gluten exposure, at least in the cultural context where our study was carried out. Children tend to perform better than teenagers or adults.

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Letter to the editor: Pasta made with sorghum flour is a valid alternative in the gluten-free diet, reducing metabolic disorders and nutritional deficiencies

Digestive and Liver Disease ◽

10.1016/j.dld.2021.06.002 ◽

2021 ◽

Author(s):

Giovanni Battista Gasbarrini ◽

Stefano Bibbò ◽

Giovanni Cammarota ◽

Antonio Gasbarrini

Keyword(s):

Metabolic Disorders ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Sorghum Flour ◽

Letter To The Editor

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Determinants And Trends Of Adherence To A Gluten-Free Diet In Adult Celiac Patients On A Long-Term Follow-Up (2000-2020)

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2020.12.015 ◽

2020 ◽

Author(s):

Annalisa Schiepatti ◽

Stiliano Maimaris ◽

Maria Luisa Nicolardi ◽

Eleonora Alimenti ◽

Marta Vernero ◽

...

Keyword(s):

Gluten Free Diet ◽

Gluten Free ◽

Long Term Follow Up

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Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review

Nutrients ◽

10.3390/nu11071588 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1588 ◽

Cited By ~ 11

Author(s):

Giovanni Di Nardo ◽

Maria Pia Villa ◽

Laura Conti ◽

Giusy Ranucci ◽

Claudia Pacchiarotti ◽

...

Keyword(s):

Systematic Review ◽

Celiac Disease ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Clinical Consequences ◽

Macro And Micronutrients ◽

High Glycemic Index ◽

Therapeutic Protocols ◽

Not At Risk

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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Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review

Medicina ◽

10.3390/medicina55070337 ◽

2019 ◽

Vol 55 (7) ◽

pp. 337 ◽

Cited By ~ 7

Author(s):

Rondanelli ◽

Faliva ◽

Gasparri ◽

Peroni ◽

Naso ◽

...

Keyword(s):

Vitamin D ◽

Folic Acid ◽

Vitamin B12 ◽

Dietary Supplementation ◽

Research Strategy ◽

Gluten Free Diet ◽

Gluten Free ◽

Micronutrient Deficiencies ◽

Good Compliance

Background and objective: Often micronutrient deficiencies cannot be detected when patient is already following a long-term gluten-free diet with good compliance (LTGFDWGC). The aim of this narrative review is to evaluate the most recent literature that considers blood micronutrient deficiencies in LTGFDWGC subjects, in order to prepare dietary supplementation advice (DSA). Materials and methods: A research strategy was planned on PubMed by defining the following keywords: celiac disease, vitamin B12, iron, folic acid, and vitamin D. Results: This review included 73 studies. The few studies on micronutrient circulating levels in long-term gluten-free diet (LTGFD) patients over 2 years with good compliance demonstrated that deficiency was detected in up to: 30% of subjects for vitamin B12 (DSA: 1000 mcg/day until level is normal, then 500 mcg), 40% for iron (325 mg/day), 20% for folic acid (1 mg/day for 3 months, followed by 400–800 mcg/day), 25% for vitamin D (1000 UI/day or more-based serum level or 50,000 UI/week if level is <20 ng/mL), 40% for zinc (25–40 mg/day), 3.6% of children for calcium (1000–1500 mg/day), 20% for magnesium (200–300 mg/day); no data is available in adults for magnesium. Conclusions: If integration with diet is not enough, starting with supplements may be the correct way, after evaluating the initial blood level to determine the right dosage of supplementation.

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A Phase I Study to Determine Safety, Tolerability and Bioactivity of Nexvax2® in HLA DQ2+ Volunteers With Celiac Disease Following a Long-Term, Strict Gluten-Free Diet

Gastroenterology ◽

10.1016/s0016-5085(11)61794-0 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-437-S-438 ◽

Cited By ~ 23

Author(s):

Gregor J. Brown ◽

James Daveson ◽

Joanne K. Marjason ◽

Rose A. Ffrench ◽

Danielle Smith ◽

...

Keyword(s):

Celiac Disease ◽

Phase I ◽

Phase I Study ◽

Gluten Free Diet ◽

Gluten Free ◽

Hla Dq2

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A266 IS A MULTIVITAMIN SUFFICIENT TO MEET NUTRITIOAL REQUIREMENTS IN CANADIAN ADULTS FOLLOWING A GLUTEN-FREE DIET?

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.265 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 143-144

Author(s):

R Chibbar ◽

D Weiten ◽

K H Green ◽

L Rigaux ◽

C N Bernstein ◽

...

Keyword(s):

Celiac Disease ◽

Calcium Supplementation ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Food Record ◽

Time Points ◽

Supplement Use ◽

Funding Agencies ◽

Dietary Supplement Use

Abstract Background Concerns exist regarding nutritional deficiencies and risk of metabolic syndrome in patients with celiac disease (CD) on a gluten-free diet (GFD). Aims This study assessed if patients with CD trying to follow a GFD meet Recommended Dietary Allowance (RDA) targets for macro- and micronutrients and the effect of supplement use in reaching RDA targets. Methods Adults (>16 years) with biopsy confirmed CD (Marsh 3) were recruited within 6 weeks of starting a GFD. Participants prospectively completed a 3-day food record, including dietary supplement use, at 6, 12, and 24 months after study entry. Macro- and micronutrient consumption was determined using the Nutrition Coordinating Center Food & Nutrient Database (NCCDB), USDA National Nutrient Database for Standard Reference (USDA SR28), and CRON-O-Meter Community Database (CCDB). RDA targets were analyzed using a paired t-test and logistic regression, adjusted for age and sex. Results Forty-nine participants (71% female; mean age 49 years) completed interpretable food records at all time points. Most (59%) used supplements and supplement use was highest at 6 months (51%). Considering macronutrients, ≥88% met the RDA for carbohydrates and protein at each time point; however, only 44% met the target for fibre. Participants who took a supplement plus a multivitamin were significantly more likely than those who took only a multivitamin to meet the RDA for vitamins B12 and D. Fewer than 20% of those who took neither a multivitamin nor an iron supplement met the RDA, whereas ≥70% of those taking a multivitamin had adequate iron intake. Participants were significantly more likely to meet RDA targets for calcium with a supplement than with a multivitamin only. Even with supplementation, ≤55% met the RDA for folate. Conclusions There is a need for ongoing monitoring and dietician support for GFD treatment in CD. Adults with celiac disease met RDA targets for protein and carbohydrate, but not fibre. While specific calcium supplementation was required to meet RDA targets for calcium, a multivitamin was generally sufficient to meet RDA targets for iron, Vitamin B12 and D. Folate was below target at all time points even with supplementation. Funding Agencies CAG, CIHRNIH

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