A23 NUTRITIONAL DEFICIENCIES ARE FREQUENT IN CELIAC PATIENTS ON A GLUTEN-FREE DIET, REGARDLESS OF THE DURATION AND COMPLIANCE OF THE DIET

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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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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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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Celiac Disease and the Gluten-Free Diet: Consequences and Recommendations for Improvement

Digestive Diseases ◽

10.1159/000369504 ◽

2015 ◽

Vol 33 (2) ◽

pp. 175-182 ◽

Cited By ~ 52

Author(s):

Thimmaiah G. Theethira ◽

Melinda Dennis

Keyword(s):

Celiac Disease ◽

Critical Role ◽

Nutrition Therapy ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Immune Mediated ◽

Macro And Micronutrients ◽

Medical Nutrition

Background: Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically susceptible individuals. CD-related enteropathy leads to multiple nutritional deficiencies involving macro- and micronutrients. Currently, medical nutrition therapy consisting of the gluten-free diet (GFD) is the only accepted treatment for CD. Key Messages: The GFD is the cornerstone of treatment for CD. Prior published studies have concluded that maintenance of the GFD results in improvement of the majority of nutritional deficiencies. In the past, counseling for CD focused mainly on the elimination of gluten in the diet. However, the GFD is not without its inadequacies; compliance to the GFD may result in certain deficiencies such as fiber, B vitamins, iron, and trace minerals. Paucity of fortified gluten-free foods may be responsible for certain deficiencies which develop on the GFD. Weight gain and obesity have been added to the list of nutritional consequences while on the GFD and have been partially attributed to hypercaloric content of commercially available gluten-free foods. Follow-up of patients diagnosed with CD after starting the GFD has been reported to be irregular and, hence, less than ideal. Conclusions: Monitoring of the nutritional status using blood tests and use of appropriate gluten-free supplementation are integral components in the management of CD. The ideal GFD should be nutrient-dense with naturally gluten-free foods, balanced with macro- and micronutrients, reasonably priced, and easily accessible. Rotation of the pseudo-cereals provides a good source of complex carbohydrates, protein, fiber, fatty acids, vitamins and minerals. Fortification/enrichment of commonly consumed gluten-free commercial grain products should be encouraged. Dietitians specializing in CD play a critical role in the education and maintenance of the GFD for patients with CD.

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

Nutrients ◽

10.3390/nu13082877 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2877

Author(s):

Aner Cardo ◽

Itziar Churruca ◽

Arrate Lasa ◽

Virginia Navarro ◽

Maialen Vázquez-Polo ◽

...

Keyword(s):

Dietary Habits ◽

Autoimmune Disorder ◽

Nutritional Composition ◽

Gluten Free Diet ◽

First Year ◽

Gluten Free ◽

Balanced Diet ◽

Group B

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

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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

International Journal of Food Sciences and Nutrition ◽

10.1080/09637486.2021.1980865 ◽

2021 ◽

pp. 1-11

Author(s):

Lucy Goddard ◽

Lina Begovich ◽

Iva Tokic ◽

Miriam E. Clegg ◽

Pariyarath Sangeetha Thondre

Keyword(s):

Body Weight ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Glycaemic Response ◽

Diet Intervention

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The Celiac Disease Patients’ Ability to Experience Pleasure

Gastroenterology Research and Practice ◽

10.1155/2019/2030751 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Fabiana Zingone ◽

Monica Siniscalchi ◽

Luna Carpinelli ◽

Paola Iovino ◽

Letizia Zingone ◽

...

Keyword(s):

Celiac Disease ◽

Sexual Activity ◽

Hospital Staff ◽

Sexual Pleasure ◽

Gluten Free Diet ◽

Physical Contact ◽

Healthy Controls ◽

Gluten Free ◽

Dietary Compliance

The motivation or ability to experience pleasure has been scarcely studied in celiac disease (CeD). We aimed to investigate the hedonistic feelings/anhedonia and sexual pleasure in CeD patients on a gluten-free diet (GFD) compared to controls. We recruited adult CeD patients at follow-up consecutively visited from April 2017 to April 2018 and controls from the hospital staff and friends of CeD patients. Participants completed the Snaith–Hamilton Pleasure Scale, measuring the levels of anhedonia, and answered three questions about physical contact, sexual activity, and modification of their life on a GFD. We included 178 CeD patients and 173 healthy controls. Seventeen patients (9.5%) and fourteen controls (8.1%) had anhedonia. We did not find any correlation between the presence of anhedonia and the length in years of GFD neither with the dietary compliance and age at the test. 10.7% patients and 8.7% controls reported of not having pleasure in physical contact and 5.06% CeD and 3.5% controls in feeling attraction for another person; 36.56% said a worsening of their life on a GFD. Our results show that CeD patients on a GFD are similar to controls in anhedonia and sexual problems, despite one-third reported a worsening of their life.

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An Attempt of Specific Desensitising Treatment with Gliadin in Celiac Disease

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463200501800413 ◽

2005 ◽

Vol 18 (4) ◽

pp. 709-714 ◽

Cited By ~ 4

Author(s):

G. Patriarca ◽

N. Pogna ◽

G. Cammarota ◽

D. Schiavino ◽

C. Lombardo ◽

...

Keyword(s):

Celiac Disease ◽

Tissue Transglutaminase ◽

Clinical Manifestations ◽

Current Treatment ◽

Gluten Free Diet ◽

Gluten Free ◽

Dietary Regimen ◽

New Approach ◽

Tissue Transglutaminase Antibodies

Gluten-free diet is the current treatment of celiac disease. We decided to verify the occurrence of histological and serological modification and/or clinical manifestations during a gradual and progressive introduction of gliadin in the diet and if it may induce a tolerance to food, as it occurs in allergic patients. We studied the case of a celiac woman with complete clinical and histological remittance after 10 years of gluten free diet. She took increasing daily doses of gliadin, reaching the final dose of 9 g of gliadin (15 g of gluten) in 6 months. Then she started a free dietary regimen. During the 15-month follow-up period esophago-gastro-duodenoscopy showed normal Kerckring folds and villi. Anti-gliadin, anti-endomysium and anti-tissue-transglutaminase antibodies, as well as the haematological and biochemical parameters remained normal. Our results represent a new approach in the research concerning celiac disease, and could provide a future line of study for its management.

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