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Macedo L, Catarino M, Festas C, Alves P. Vulnerability in Children with Celiac Disease: Findings from a Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:729. [PMID: 38929308 PMCID: PMC11201835 DOI: 10.3390/children11060729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
(1) Background: The scientific literature highlights that children diagnosed with celiac disease (CD) are at a heightened risk of experiencing physical, psychological, and social challenges, impacting their overall healthy childhood development. However, there remains a lack of a clear understanding regarding the factors that contribute to this vulnerability. The purpose of this study is to analyze and map the evidence on the sociopsychosomatic vulnerability of these children and identify gaps in this topic. (2) Methods: Following Joanna Briggs Institute's guidelines for scoping reviews, we executed a detailed search of key electronic databases and explored the grey literature to capture a broad spectrum of studies. Our focus was on identifying research that looked into the multiple dimensions of vulnerability-physical, psychological, and social-in children with CD. We included a diverse range of study designs as well as systematic reviews, ensuring a comprehensive analysis. The selection process was stringent, utilizing clearly defined inclusion and exclusion criteria. (3) Results: We identified 61 studies that met our inclusion criteria. The review highlighted significant adverse health outcomes in children with CD and elucidated various individual and environmental determinants that influenced these vulnerabilities. It also underscored the lack of assessment tools to evaluate the risk of health problems in this population. (4) Conclusions: The findings underscore a critical need for further research to deepen our understanding of the vulnerabilities associated with CD in children. Developing targeted assessment tools will be crucial in stratifying health risks and enhancing care strategies for this vulnerable population.
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Affiliation(s)
- Lúcia Macedo
- Âncora Community Care Unit, Gaia and Espinho Local Health Unit, 4430-037 Gaia, Portugal
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (C.F.); (P.A.)
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Marta Catarino
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
- Health Department, Polytechnic Institute of Beja, 7800-111 Beja, Portugal
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Constança Festas
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (C.F.); (P.A.)
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Paulo Alves
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (C.F.); (P.A.)
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
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Gorini F, Tonacci A. Vitamin D: An Essential Nutrient in the Dual Relationship between Autoimmune Thyroid Diseases and Celiac Disease-A Comprehensive Review. Nutrients 2024; 16:1762. [PMID: 38892695 PMCID: PMC11174782 DOI: 10.3390/nu16111762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Autoimmune thyroid diseases (AITD) are among the most frequent autoimmune disorders, with a multifactorial etiology in which both genetic and environmental determinants are probably involved. Celiac disease (CeD) also represents a public concern, given its increasing prevalence due to the recent improvement of screening programs, leading to the detection of silent subtypes. The two conditions may be closely associated due to common risk factors, including genetic setting, changes in the composition and diversity of the gut microbiota, and deficiency of nutrients like vitamin D. This comprehensive review discussed the current evidence on the pivotal role of vitamin D in modulating both gut microbiota dysbiosis and immune system dysfunction, shedding light on the possible relevance of an adequate intake of this nutrient in the primary prevention of AITD and CeD. While future technology-based strategies for proper vitamin D supplementation could be attractive in the context of personalized medicine, several issues remain to be defined, including standardized assays for vitamin D determination, timely recommendations on vitamin D intake for immune system functioning, and longitudinal studies and randomized controlled trials to definitely establish a causal relationship between serum vitamin D levels and the onset of AITD and CeD.
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Affiliation(s)
- Francesca Gorini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy;
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Oliveira DDDC, da Silva DCG, Kawano MM, de Castro CT, Pereira M. Effect of a gluten-free diet on bone mineral density in children and adolescents with celiac disease: Systematic review and meta-analysis. Crit Rev Food Sci Nutr 2022; 64:5192-5202. [PMID: 36469632 DOI: 10.1080/10408398.2022.2153103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Studies suggest an association between a gluten-free diet (GFD) and bone health in celiac disease (CD). However, the evidence on this relationship in children and adolescents is limited. Thus, this systematic review and meta-analysis aimed to analyze the effect of GFD on the bone health and anthropometric profile of children and adolescents with CD. Five databases were searched up to January, 2022 to identify relevant studies. The studies' methodological quality was evaluated using two scales. The Hedge's g standardized mean differences (SMD) with 95% confidence intervals were estimated using a random-effects model. The GRADE approach was used to assess the quality of evidence. Twenty-eight studies were included in the final review. GFD increased bone mineral content (BMC) (SMD = 0.39; 95%CI = 0.16, 0.62) and bone mineral density (BMD) (SMD = 0.29; 95%CI = 0.10, 0.47) in CD individuals. Difference in mean BMC and BMD between children and adolescents with CD versus healthy individuals was -0.49 (95%CI = -0.76, -0.22) and -0.47 (SMD = -95%CI = -0.72, -0.22), respectively. There was no difference in BMI and body fat among celiac children and adolescents versus healthy controls. In conclusion, GFD was associated with higher BMC and BMD in children and adolescents with CD.
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Affiliation(s)
| | | | - Marcio Massao Kawano
- Center of Biological and Health Sciences, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | | | - Marcos Pereira
- Institute of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
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Trasciatti S, Piras F, Bonaretti S, Marini S, Nencioni S, Biasci E, Egan CG, Nannipieri F. Effect of oral cholecalciferol in a murine model of celiac disease: A dose ranging study. J Steroid Biochem Mol Biol 2022; 220:106083. [PMID: 35257869 DOI: 10.1016/j.jsbmb.2022.106083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/20/2022] [Accepted: 02/18/2022] [Indexed: 12/16/2022]
Abstract
Previous studies have shown a relationship between vitamin D and celiac disease (CD), however little evidence is available examining the direct effects of vitamin D on pathological features of this disease. In this study we evaluated the effect of oral administration of different doses of native vitamin D3 (cholecalciferol) in enteropathic mice. Female non-obese diabetic (NOD)/ShiLt.J mice were fed standard or gluten-free diet and administered gliadin (5 μg/kg) to induce a celiac pathology. Healthy control (gluten-free diet, without gliadin) and control for pathology (standard diet, with gliadin) were administered olive oil. All other experimental groups received gliadin and standard diet plus oral cholecalciferol (5, 10, 20, 50 and 130 μg/kg). Serum levels of 25(OH)D3, calcium and zonulin and expression of vitamin D receptor (VDR), CD3 and zonula occludens-1 (ZO-1) by immunohistochemistry as well as intestinal histological and histomorphometric analyses were undertaken. Although no difference in serum levels of 25(OH)D3, calcium or zonulin was observed in cholecalciferol-treated mice vs. healthy controls, a significant improvement in intestinal mucosa pathological features in mice administered cholecalciferol was observed by histological analysis. Villi length was also significantly increased by cholecalciferol in a dose-dependent manner. Immunohistochemical staining revealed increased expression of CD3 and ZO-1 in celiac mice compared to mice receiving high dose (130 μg/kg) cholecalciferol. These findings show the effect of oral cholecalciferol on signature features of CD in a mouse model of CD. Further dose-ranging studies to investigate the efficacy of cholecalciferol for the treatment of CD are warranted.
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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Dehghani SM, Ilkhanipour H, Samipour L, Niknam R, Shahramian I, Parooie F, Salarzaei M, Tahani M. Investigation of the Factors Affecting Bone Mineral Density in Children with Celiac Disease. Pediatr Gastroenterol Hepatol Nutr 2022; 25:138-146. [PMID: 35360377 PMCID: PMC8958055 DOI: 10.5223/pghn.2022.25.2.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/09/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Children with celiac disease (CD) are at an increased risk of low bone mineral density (BMD) owing to malabsorption of fat-soluble vitamins, inflammation, and malnutrition. This study aimed to determine the prevalence and risk factors for low BMD in Iranian children with CD. METHODS This prospective cohort study examined 149 Iranian children with CD between 2011 and 2018 at Zabol University of Medical Sciences. BMD was measured using dual-energy X-ray absorptiometry. Demographic, clinical, and laboratory data were collected from patients' medical records. Logistic regression analysis was performed to identify the factors associated with low areal BMD (BMD-Z <-2) in the lumbar spine and femoral neck. Descriptive data were analyzed using the mean, standard deviation, and relative frequency. Data were analyzed using the chi-square test, t-test, and analysis of variance. RESULTS Of the 149 children with CD, 27.5% had osteoporosis. The mean body mass index (BMI) Z score was -1.28±1.2. Lower BMI was associated with a higher likelihood of BMD-Z (odds ratio 2.17; p≤0.05). CONCLUSION Overall, the findings of this study showed that there was no correlation among Marsh classification, presence of specific human leukocyte antigens, and low BMD in Iranian children with CD. BMI can be a predictor of bone density in children with CD and may be applied clinically in early screenings to evaluate the bone health status in these children.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Shiraz Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Homa Ilkhanipour
- Department of Pediatric, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Samipour
- Department of Pediatric, Shiraz University of Medical Science, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Iraj Shahramian
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Fateme Parooie
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Morteza Salarzaei
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Masoud Tahani
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
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Verma A, Lata K, Khanna A, Singh R, Sachdeva A, Jindal P, Yadav S. Study of effect of gluten-free diet on vitamin D levels and bone mineral density in celiac disease patients. J Family Med Prim Care 2022; 11:603-607. [PMID: 35360767 PMCID: PMC8963631 DOI: 10.4103/jfmpc.jfmpc_1190_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Celiac disease (CD) is a multifactorial immune-mediated enteropathy caused by a response to ingested gluten. The current available treatment for CD is lifelong gluten-free diet (GFD). This study was done to see the effect of GFD on Vitamin D levels and bone mass density in celiac patients. Methods: A prospective interventional study on newly diagnosed celiac patients was conducted in the Pediatrics department of a tertiary care teaching institute in 2 stages viz. on presentation and after 6 months of GFD. Anthropometric measurements, biochemical investigations, Vitamin D levels, and DEXA scan was done at recruitment and after 6 months of GFD and was analyzed. Results: In newly diagnosed 60 pediatric celiac patients, positive effect of GFD on anthropometry, hemoglobin, Vitamin D levels, DEXA scan parameters was observed. Significant difference was found in Vitamin D levels which increased from baseline 14.85 ± 5.39 to 18.22 ± 5.67 ng/ml after 6 months of GFD (P < 0.05). Significant difference was found in BMD (mean Z-score) which increased from -0.941 ± 0.738 to -0.640 ± 0.60 after 6 months of GFD (P < 0.001). Conclusion: Our study concluded that there is significant increase in vitamin D levels as well as Z-score, bone mass density (BMD) and bone Mass Content (BMC) after 6 months of GFD.
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Nestares T, Martín-Masot R, de Teresa C, Bonillo R, Maldonado J, Flor-Alemany M, Aparicio VA. Influence of Mediterranean Diet Adherence and Physical Activity on Bone Health in Celiac Children on a Gluten-Free Diet. Nutrients 2021; 13:1636. [PMID: 34068001 PMCID: PMC8152289 DOI: 10.3390/nu13051636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/25/2021] [Accepted: 05/11/2021] [Indexed: 12/20/2022] Open
Abstract
We aimed to assess the influence of the Mediterranean Diet adherence and physical activity (PA) on body composition, with a particular focus on bone health, in young patients with celiac disease (CD). The CD group (n = 59) included children with CD with a long (>18 months, n = 41) or recent (<18 months, n = 18) adherence to a gluten-free diet (GFD). The non-celiac group (n = 40) included non-celiac children. After adjusting for potential confounders, the CD group showed lower body weight (p = 0.034), lean mass (p = 0.003), bone mineral content (p = 0.006), and bone Z-score (p = 0.036) than non-celiac children, even when the model was further adjusted for adherence to a GFD for at least 18 months. Among CD children, spending greater time in vigorous physical activity was associated with higher lean mass (p = 0.020) and bone mineral density with evidence of statistical significance (p = 0.078) regardless of the time they followed a GFD. In addition, a greater Mediterranean Diet adherence was associated with a higher bone Z-score (p = 0.020). Moreover, lean mass was strongly associated with bone mineral density and independently explained 12% of its variability (p < 0.001). These findings suggest the importance of correctly monitoring lifestyle in children with CD regarding dietary habits and PA levels to improve lean mass and, consequently, bone quality in this population.
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Affiliation(s)
- Teresa Nestares
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology “José MataixVerdú” (INYTA), University of Granada, 18071 Granada, Spain
| | - Rafael Martín-Masot
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Malaga, 29010 Málaga, Spain;
| | | | - Rocío Bonillo
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
| | - José Maldonado
- Department of Pediatrics, University of Granada, 18071 Granada, Spain;
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Virgen de las Nieves, 18071 Granada, Spain
- Spain Maternal and Child Health Network, Carlos III Health Institute, 28029 Madrid, Spain
| | - Marta Flor-Alemany
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology “José MataixVerdú” (INYTA), University of Granada, 18071 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain
| | - Virginia A. Aparicio
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain
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Bishop J, Ravikumara M. Coeliac disease in childhood: An overview. J Paediatr Child Health 2020; 56:1685-1693. [PMID: 33197972 DOI: 10.1111/jpc.14674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
Coeliac disease (CD) is an autoimmune condition, characterised by an immunological response to ingestion of gluten in genetically susceptible individuals, affecting about 1% of the population in many regions of the world. Increased knowledge regarding the pathogenesis, improved diagnostic techniques and increased awareness over the years have transformed our understanding of CD such that it is no longer a rare enteropathy, but rather a common multisystem disorder which affects individuals of all ages and results in wide-ranging clinical manifestations. Only a minority of children now present with the classical clinical picture of profound diarrhoea and malnutrition. An increasing number of children with CD present with either mild, non-specific gastrointestinal symptoms or extra-intestinal manifestations or even be asymptomatic, as in many screening-detected children. Knowledge about these diverse manifestations and a high index of suspicion is essential so that appropriate investigations can be undertaken, diagnosis established and treatment initiated. Although traditionally small bowel biopsy is considered essential for the diagnosis, recent guidelines from various professional bodies have paved the way to a biopsy-free diagnosis in a subset of symptomatic children. Life long, strict gluten-free diet still remains the only effective treatment at present, although several novel therapeutic agents are in various phases of clinical trials.
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Affiliation(s)
- Jonathan Bishop
- Department of Gastroenterology, Starship Hospital, Auckland, New Zealand
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Western Australia, Australia
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Nutrition Assessment, Interventions, and Monitoring for Patients with Celiac Disease: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 120:1381-1406. [PMID: 31953154 DOI: 10.1016/j.jand.2019.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Indexed: 11/21/2022]
Abstract
The objectives of this scoping review were to identify and characterize studies examining nutrition assessment, interventions, and measures to monitor gluten-free diet (GFD) adherence/compliance in patients with celiac disease (CD). An electronic literature search of four databases (Cochrane Database for systematic reviews, CINAHL, Embase, and Ovid MEDLINE) was conducted to identify articles examining nutrition care in CD individuals. Except for narrative review, grey literature, and case study/report, all types of peer-reviewed articles published between January 2007 and August 2018 were eligible. There were a total of 10,823 records; 10,368 were excluded during the first round of screening due to irrelevancy and/or duplication. Of the 455 full-text articles that were assessed, 292 met the criteria and were included. Most of the studies were observational studies (n=212), followed by experimental trials (n=50), evidence-based practice guideline (EBPG)/report/statement (n=16), and systematic review (SR) (n=14). Nine original studies examined assessment, focusing mainly on different tools/ways to assess GFD adherence. The majority of the included original articles (n=235) were in the nutrition intervention category with GFD, oats, and prebiotics/probiotics as the top-three most studied interventions. There were eight SRs on GFD and five on oats. One SR and 21 original studies investigated the effectiveness of different measures to monitor GFD adherence/compliance. Although recent CD EBPGs were identified, different methods with varying levels of rigor, in terms of literature search and assessment of evidence strength, were used. Based on this scoping review, interventions focused on gluten-free diet and oats have been significantly covered by either SRs or EBPGs. Studies related to prebiotics/probiotics and education program/counseling focused interventions, as well as assessment, in CD patients have increased in recent years. Thus, it might be beneficial to conduct SRs/EBPGs focused on these topics to guide practitioners.
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Coşkun ME, Hizli Ş, Yavuz S, Temel MT. Score-based diagnostic approach to celiac disease and bone mineral density. Pediatr Int 2019; 61:1015-1019. [PMID: 31486579 DOI: 10.1111/ped.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to assess the performance of a score-based diagnostic approach (SBDA) proposed in the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2012 guideline, and the usefulness of bone mineral density (BMD) measurement in SBDA as an objective finding in the diagnosis of celiac disease (CD). METHODS The SBDA scores of 153 biopsy-proven celiac diagnosed children (derived from symptomatology, serology, human leukocyte antigen [HLA] analysis, histology) were calculated. Additionally, BMD Z scores obtained at diagnosis were also investigated. The diagnostic sensitivity of SBDA was tested in different scenarios in which low BMD was scored as a diagnostic finding. RESULTS The mean age of children was 9.48 ± 3.59 years and 54.2% were female. All patients scored ≥4, which is the minimum score to diagnose CD in SBDA. Mean BMD Z score in 142 of 153 patients was -2.70 ± 1.16, and 73.9% of them were below -2. Moreover, different diagnostic scenarios without histology were tested. In one of them, BMD and HLA were not included and the sensitivity was 85.2%. In another one, low BMD was scored as an equivalent of malabsorption, HLA was not included and sensitivity was 97.2%. The sensitivities of these scenarios were significantly different (P = 0.001). CONCLUSION In the absence of both HLA and histology, accepting low BMD as an equivalent of malabsorption drastically increased the diagnostic sensitivity, while SBDA had limited success. Therefore, BMD might be useful when HLA and biopsy are not available.
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Affiliation(s)
| | - Şamil Hizli
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Sibel Yavuz
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Adana Çukurova University, Adana, Turkey
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Drabińska N, Jarocka-Cyrta E, Złotkowska D, Abramowicz P, Krupa-Kozak U. Daily oligofructose-enriched inulin intake impacts bone turnover markers but not the cytokine profile in pediatric patients with celiac disease on a gluten-free diet: Results of a randomised, placebo-controlled pilot study. Bone 2019; 122:184-192. [PMID: 30840918 DOI: 10.1016/j.bone.2019.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/17/2019] [Accepted: 03/02/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bone metabolism disturbances are commonly observed in patients with newly diagnosed celiac disease (CD). The only available treatment for CD-the intake of a gluten-free diet (GFD)-has been found to be insufficient in effectively improving bone health in some patients. Therefore, there is an urgent need to modify the GFD so as to allow for the provision of all the necessary nutrients and improved absorption. Prebiotics intake reportedly improves the absorption of bone-related vitamin D and calcium as well as bone metabolism. The effect of prebiotic intake on bone health in CD patients has not been studied yet. This study aimed to evaluate the effect of oligofructose-enriched inulin intake on bone metabolism and immune response in children with CD on a GFD. METHODS A total of 34 children with CD were randomised into two groups receiving 10 g of oligofructose-enriched inulin (Synergy 1) or a placebo (maltodextrin) for three months, together with a strict GFD. The children's bone metabolism marker levels and cytokine profiles were analysed before and after the intervention. RESULTS After supplementation, the concentration of osteocalcin increased significantly in children receiving Synergy 1, while the concentration of bone alkaline phosphatase increased in both groups, independent of supplementation. After the intervention, the level of pyridinoline increased significantly in the placebo group, resulting in a concentration that was two times higher than that in the Synergy 1 group, in which it remained stable. Moreover, the plasma concentrations of N-terminal telopeptides of type I collagen decreased in both the groups, whereas the tartrate-resistant acid phosphatase 5b level increased particularly in the Synergy 1 group. The intervention did not lead to immunological response changes. CONCLUSIONS The proposed supplementation beneficially altered bone metabolism, through increased bone formation rates and decreased bone resorption process rates. Supplementation of GFD with prebiotic oligofructose-enriched inulin may be a promising auxiliary therapy for bone metabolism improvements in children with CD.
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Affiliation(s)
- Natalia Drabińska
- Department of Chemistry and Biodynamics of Food, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland.
| | - Elżbieta Jarocka-Cyrta
- Department of Pediatrics, Gastroenterology and Nutrition Collegium Medicum School of Medicine University of Warmia and Masuria, Żołnierska 18A Str., 10-561 Olsztyn, Poland.
| | - Dagmara Złotkowska
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland.
| | - Paweł Abramowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok, Poland.
| | - Urszula Krupa-Kozak
- Department of Chemistry and Biodynamics of Food, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland.
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Neves FS, Barros AS, Cerqueira GA, Cruz GA, Reis AA, Alves LB, Crusoé-Rebello I. Assessment of fractal dimension and panoramic radiomorphometric indices in women with celiac disease. Oral Radiol 2019; 36:141-147. [DOI: 10.1007/s11282-019-00388-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/20/2019] [Indexed: 12/11/2022]
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14
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Jericho H, Guandalini S. Extra-Intestinal Manifestation of Celiac Disease in Children. Nutrients 2018; 10:nu10060755. [PMID: 29895731 PMCID: PMC6024684 DOI: 10.3390/nu10060755] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of this literature review is to discuss the extra-intestinal manifestations of celiac disease within the pediatric celiac population.
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Affiliation(s)
- Hilary Jericho
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Celiac Disease Center-Comer Children's Hospital, Chicago, IL 60637, USA.
| | - Stefano Guandalini
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Celiac Disease Center-Comer Children's Hospital, Chicago, IL 60637, USA.
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15
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Celiac Disease in India - Status Update. Indian J Pediatr 2017; 84:337-338. [PMID: 28247175 DOI: 10.1007/s12098-017-2320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
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16
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Maggioli C, Stagi S. Bone modeling, remodeling, and skeletal health in children and adolescents: mineral accrual, assessment and treatment. Ann Pediatr Endocrinol Metab 2017; 22:1-5. [PMID: 28443253 PMCID: PMC5401817 DOI: 10.6065/apem.2017.22.1.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/20/2022] Open
Abstract
The modeling and remodeling process of the bone is fundamental to maintaining its integrity and mechanical properties. Many physical and biochemical factors during childhood and adolescence are crucially important for the development of healthy bones. Systemic conditions, such as hormonal status, nutrition, physical inactivity, or many pharmacological treatments, as well as a local variation in the load, can influence bone turnover and, consequently, the attainment of a proper peak bone mass. However, many diseases affecting children and adolescents can be associated with a reduction in bone accrual or a loss of bone mass and quality, which leads to an increased risk of fracture over one's life. In this review, we examine the effects of genetics, physical activity, chronic diseases and pharmacological treatments, and dietary factors on bone integrity in children and adolescents. We also briefly describe the specific tools that are currently used in assessing bone health.
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Affiliation(s)
- Chiara Maggioli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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