Long-Term Follow-Up of Celiac Adults on Gluten-Free Diet: Prevalence and Correlates of Intestinal Damage

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

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.022 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 27-28

Author(s):

A Jivraj ◽

V Connan ◽

T Balart ◽

E Ching ◽

A Marwaha ◽

...

Keyword(s):

Tissue Transglutaminase ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Dietary Compliance ◽

Persistent Symptoms ◽

Funding Agencies ◽

Adherence Test

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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Wheat Starch-Containing Gluten-Free Flour Products in the Treatment of Coeliac Disease and Dermatitis Herpetiformis: A Long-Term Follow-up Study

Scandinavian Journal of Gastroenterology ◽

10.1080/00365529950173023 ◽

1999 ◽

Vol 34 (2) ◽

pp. 163-169 ◽

Cited By ~ 46

Author(s):

K. Kaukinen, P. Collin, K. Holm, I.

Keyword(s):

Coeliac Disease ◽

Dermatitis Herpetiformis ◽

Wheat Starch ◽

Gluten Free ◽

Follow Up Study ◽

Long Term Follow Up

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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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