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

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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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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Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies

Gastroenterology ◽

10.1053/j.gastro.2017.04.009 ◽

2017 ◽

Vol 153 (2) ◽

pp. 395-409.e3 ◽

Cited By ~ 37

Author(s):

María Inés Pinto-Sánchez ◽

Natalia Causada-Calo ◽

Premysl Bercik ◽

Alexander C. Ford ◽

Joseph A. Murray ◽

...

Keyword(s):

Systematic Review ◽

Celiac Disease ◽

Observational Studies ◽

Meta Analysis ◽

Gluten Free Diet ◽

Gluten Free

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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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Dermatomyositis Associated with Celiac Disease: Response to a Gluten-Free Diet

Canadian Journal of Gastroenterology ◽

10.1155/2006/574074 ◽

2006 ◽

Vol 20 (6) ◽

pp. 433-435 ◽

Cited By ~ 20

Author(s):

Min Soo Song ◽

David Farber ◽

Alain Bitton ◽

Jeremy Jass ◽

Michael Singer ◽

...

Keyword(s):

Celiac Disease ◽

Adult Population ◽

Gastrointestinal Symptoms ◽

Human Leukocyte ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Deficiency Anemia ◽

Gluten Free ◽

Disease Response ◽

Vitamin Deficiencies

The association between dermatomyositis and celiac disease in children has been well documented. In the adult population, however, the association has not been clearly established. A rare case of concomitant dermatomyositis and celiac disease in a 40-year-old woman is presented. After having been diagnosed with dermatomyositis and iron deficiency anemia, this patient was referred to the gastroenterology clinic to exclude a gastrointestinal malignancy. Blood tests revealed various vitamin deficiencies consistent with malabsorption. The results of gastroscopy with duodenal biopsy were consistent with celiac disease. After she was put on a strict gluten-free diet, both nutritional deficiencies and the dermatomyositis resolved. The patient’s human leukocyte antigen haplotype study was positive for DR3 and DQ2, which have been shown to be associated with both juvenile dermatomyositis and celiac disease. It is suggested that patients with newly diagnosed dermatomyositis be investigated for concomitant celiac disease even in the absence of gastrointestinal symptoms.

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Tu1393 Celiac Disease and Adherence to the Gluten-Free Diet - A Systematic Review and Meta-Analyses

Gastroenterology ◽

10.1016/s0016-5085(16)33018-9 ◽

2016 ◽

Vol 150 (4) ◽

pp. S893

Author(s):

Anna Myleus ◽

Norelle R. Reilly ◽

Peter Green

Keyword(s):

Systematic Review ◽

Celiac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Meta Analyses

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The Gluten-Free Diet for Celiac Disease and Beyond

Nutrients ◽

10.3390/nu13113993 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3993

Author(s):

Bara Aljada ◽

Ahmed Zohni ◽

Wael El-Matary

Keyword(s):

Celiac Disease ◽

Dermatitis Herpetiformis ◽

Cognitive Disorders ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Sensitivity ◽

Gluten Free ◽

Immune Mediated ◽

The Brain

The gluten-free diet (GFD) has gained popularity beyond its main medical indication as the treatment for gluten-induced immune-mediated disorders such as celiac disease (CD), dermatitis herpetiformis, gluten ataxia, wheat allergy, and non-celiac gluten sensitivity. However, the diet carries some disadvantages such as elevated costs, nutritional deficiencies, and social and psychological barriers. The present work aims to review indications, proven benefits, and adverse events of a gluten-free diet. Close follow-up with patients following the diet is recommended. More data is needed to assess the effectiveness of the diet in managing mental and cognitive disorders and to establish a connection between the brain and gluten.

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Knowledge of Medical Students and Medical Professionals Regarding Nutritional Deficiencies in Patients with Celiac Disease

Nutrients ◽

10.3390/nu13061771 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1771

Author(s):

Łukasz Dembiński ◽

Artur Mazur ◽

Mariusz Dąbrowski ◽

Teresa Jackowska ◽

Aleksandra Banaszkiewicz

Keyword(s):

Vitamin D ◽

Celiac Disease ◽

Medical Students ◽

Healthcare Professionals ◽

Gluten Free Diet ◽

Acceptable Level ◽

Excessive Amount ◽

Nutritional Deficiencies ◽

Medical Professionals ◽

Gluten Free

A gluten-free diet provides relief from symptoms for patients with celiac disease, although there is still a risk of nutritional deficiencies. These patients can potentially consume an excessive amount of fat and insufficient amounts of fiber, iron, vitamin D, and calcium. This study aimed to assess the knowledge of medical students and healthcare professionals in Poland regarding nutritional deficiencies and the prevention of such deficiencies in patients with celiac disease who are on a gluten-free diet. Of the 430 survey participants, 46% did not realize the risk of nutritional deficiencies in patients with celiac disease. The knowledge of the participants was lowest regarding the risk of being overweight or obese. Among the healthcare professionals, an acceptable level of correct answers was provided by only 37% of individuals and was highest for the dietitians’ group. Our results demonstrate the need to improve the education of healthcare professionals concerning nutrition in patients with celiac disease.

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