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

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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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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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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One-year follow-up of the nutritional status of celiac people on a gluten-free diet

10.21203/rs.3.rs-445540/v1 ◽

2021 ◽

Author(s):

Gesala Perez-Junkera ◽

Maialen Vazquez-Polo ◽

Francisco Jose Eizagirre ◽

Laura Benjumea ◽

Carlos Tutau ◽

...

Keyword(s):

Nutritional Status ◽

Dietary Habits ◽

Clinical Investigation ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Dietary Advice ◽

Gluten Free ◽

Dietary Counseling ◽

One Year

Abstract Background The gluten-free diet (GFD), the only effective treatment for celiac disease, is usually nutritionally imbalanced. The present work aimed to analyze the evolution of the nutritional status, dietary profile, and symptoms present among celiac people over one year on a GFD while receiving individualized dietary advice. Methods Twenty-seven adults and thirty-one celiac children/adolescents participated in the cohort study. They were followed by 3 visits, at diagnosis (vt0) and after 3 and 12 months (vt3;vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires and received a personalized form from dietitians containing dietary advice and anthropometric and biochemical data evolution. Results Most patients presented normal BMI, fat and muscle mass, and biochemical parameters at diagnosis and vt12. By contrast, all participants consumed protein and lipids in excess and carbohydrates in defect, in both vt0 and vt12. Low intakes of cereals, fruits and vegetables and high of meat were observed, these also remain-ing unchanged after dietary counseling. Symptoms present decreased after vt3 but rebounded in vt12. Conclusions Few changes in dietary pattern and symptom elimination suggested that the intervention was not effective enough. More research is necessary to evaluate whether closer follow up and face-to-face dietary advice improve dietary habits of celiac people. Trial registration: Code PI2016069, Ethical Comitee of the Clinical Investigation of the Basque Country. Registered on 15 July 2016.

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M2033 Role of Antibodies in the Long Term Follow Up of Patients with Celiac Disease to Predict the Adherence to Gluten-Free Diet

Gastroenterology ◽

10.1016/s0016-5085(09)62167-3 ◽

2009 ◽

Vol 136 (5) ◽

pp. A-471

Author(s):

Adriana Mohaidle ◽

José M. Mella ◽

Lisandro Pereyra ◽

Pablo Luna ◽

Carolina Fischer ◽

...

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Long Term Follow Up

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Improving gluten free diet adherence by youth with celiac disease

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2019-0026 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Dory Sample ◽

Justine Turner

Keyword(s):

Celiac Disease ◽

Personal Autonomy ◽

Peer Acceptance ◽

Autoimmune Disorder ◽

Gluten Free Diet ◽

Self Management ◽

Gluten Free ◽

Diet Adherence ◽

Management Approaches

Abstract Introduction Celiac disease (CD) is a gluten-triggered autoimmune disorder of the small intestine, which can occur in genetically susceptible individuals at any age. A strict life-long gluten free diet (GFD) is the only medically approved treatment, and non-adherence is associated with significant morbidity. However, gluten use is widespread, complicating efforts to follow the diet. Youth with CD are especially challenged with dietary adherence, as they strive for peer acceptance and personal autonomy in the context of managing a chronic disease. Methods A scoping review was conducted to identify mechanisms to assist youth with remaining gluten free. Results There is a paucity of literature regarding best approaches to improve diet adherence by youth, however, lessons can also be learned by borrowing ideas from self-management approaches of other chronic diseases. Several mechanisms for improving GFD adherence among youth are identified, including regular engagement of the youth with CD and their family with an experienced multidisciplinary team, electronic tool utilization and awareness of accurate resources for self-guided education and resources. Conclusions Improvement in GFD adherence by youth is achievable and may influence long-term health outcomes.

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