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Barone M, Iannone A, Cristofori F, Dargenio VN, Indrio F, Verduci E, Di Leo A, Francavilla R. Risk of obesity during a gluten-free diet in pediatric and adult patients with celiac disease: a systematic review with meta-analysis. Nutr Rev 2023; 81:252-266. [PMID: 35947766 PMCID: PMC10857815 DOI: 10.1093/nutrit/nuac052] [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: 11/13/2022] Open
Abstract
CONTEXT Obesity is a significant risk factor for many pathological conditions. Whether a gluten-free diet (GFD) is a risk factor for overweight or obesity remains controversial. OBJECTIVE The primary aim of this study was to assess the prevalence of body mass index (BMI) categories at disease presentation and the variation in BMI category from underweight/normal to overweight/obese and vice versa during a GFD. DATA SOURCES PubMed, Scopus, and Web of Science databases were searched through February 2021 for retrospective, cross-sectional, and prospective studies reporting BMI categories at disease diagnosis and during a GFD. DATA EXTRACTION Data were extracted by 2 reviewers independently. Disagreements were resolved by consensus; a third reviewer was consulted, if necessary. Risk of bias was assessed with the Cochrane ROBINS-I tool. DATA ANALYSIS Subgroup analysis based on age (pediatric/adult patients), study design (prospective, cross-sectional, retrospective), and duration of GFD was performed.. Forty-five studies were selected (7959 patients with celiac disease and 20 524 healthy controls). The mean BMI of celiac patients at presentation was significantly lower than that of controls (P < 0.001). During a GFD, the mean BMI increased significantly (mean difference = 1.14 kg/m2 [95%CI, 0.68-1.60 kg/m2]; I2 = 82.8%; P < 0.001), but only 9% of patients (95%CI, 7%-12%; I2 = 80.0%) changed from the underweight/normal BMI category to the overweight/obese category, while 20% (95%CI, 11%-29%; I2 = 85.8%) moved into a lower BMI category. CONCLUSION Most celiac patients had a normal BMI at presentation, although the mean BMI was significantly lower than that of controls. A GFD does not increase the risk of becoming overweight/obese, especially in children. The quality of several studies was suboptimal, with moderate or high overall risk of bias and heterogeneity.
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Affiliation(s)
- Michele Barone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Andrea Iannone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Fernanda Cristofori
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Vanessa Nadia Dargenio
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Flavia Indrio
- is with the Department of Pediatrics, Scientific Institute “Casa Sollievo della Sofferenza,” Foggia, Italy
| | - Elvira Verduci
- is with the Department of Pediatrics, Ospedale dei Bambini “Vittore Buzzi,” Milan, Italy
| | - Alfredo Di Leo
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Ruggiero Francavilla
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
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Mozzillo E, Franceschi R, Di Candia F, Rosanio FM, Leonardi L, Fedi L, Rosà V, Cauvin V, Franzese A, Loredana Marcovecchio M. The impact of gluten-free diet on growth, metabolic control and quality of life in youth with type 1 diabetes and celiac disease: A systematic review. Diabetes Res Clin Pract 2022; 191:110032. [PMID: 35934174 DOI: 10.1016/j.diabres.2022.110032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the impact of gluten free diet (GFD) on growth, metabolic control and quality of life in children and adolescents with type 1 diabetes (T1D) and celiac disease (CD). METHODS A systematic search was performed including studies published in the last 15 years. PICOS framework was used in the selection process and evidence was assessed using the GRADE system. RESULTS Overall, studies comparing youth with T1D + CD on GFD to those with T1D only, showed no significant differences in growth parameters, HbA1c, number of episodes of hypoglycemia, total daily insulin doses. Studies assessing the effect of GFD introduction showed stable BMI and HbA1c. Only two studies assessed QoL of life, which was not different between T1D + CD vs T1D only youth, as well as pre- and post-CD diagnosis and introduction of GFD. CONCLUSION This systematic review, including only studies of moderate-high evidence quality level and reporting data on objectively assessed adherence to GFD, highlights that adherence to GFD in youth with T1D + CD leads to regular growth, stable BMI, without any negative effect on HbA1c and insulin requirements. Although assessed in few studies, lipid profile and QoL improved with the introduction of GFD.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy.
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Francesco Maria Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| | - Ludovica Fedi
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Valentina Rosà
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| | - Vittoria Cauvin
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Adriana Franzese
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Does a Gluten-Free Diet Affect BMI and Glycosylated Hemoglobin in Children and Adolescents with Type 1 Diabetes and Asymptomatic Celiac Disease? A Meta-Analysis and Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081247. [PMID: 36010137 PMCID: PMC9406674 DOI: 10.3390/children9081247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood glucose levels. This review aims to assess the efficacy and effectiveness of managing patients with T1DM screened for CD with GFD to prevent complications associated with these chronic pathologies in childhood and adulthood. Materials and Methods: We abided by the PRISMA guidelines in this meta-analysis and used multiple databases and search engines. We included case−control studies. The primary outcomes were changes in the standard deviation score, body mass index (SDS BMI), and glycosylated hemoglobin (HA1C) after being on a GFD for at least twelve months. Results: The pooled data from the six studies included showed that there was neither a statistically significant difference in the mean SDS BMI (−0.28 (95% CI −0.75, 0.42)) (p = 0.24) nor in the mean of HA1C (mean −0.07 (95% CI −0.44, 0.30)) (p = 0.36) for the same group. HDL cholesterol improved significantly in patients on a strict GFD (p < 0.01). Conclusions: In children with T1DM and asymptomatic CD, being on a GFD had no significant effect on BMI or HA1C. However, it can have a protective effect on the other complications found in both chronic pathologies.
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Kakkar R, Fung A, Barker C, Foster A, Hursh BE. The Experience of a Gluten-free Diet in Children with Type 1 Diabetes and Celiac Disease. J Can Assoc Gastroenterol 2022; 5:25-31. [PMID: 35118224 PMCID: PMC8806040 DOI: 10.1093/jcag/gwab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study examined overall self-reported adherence to gluten-free diet (GFD) in children with type 1 diabetes and celiac disease (T1DCD) compared to children with celiac disease (CD). Secondary objectives included gaining insight into self-reported symptoms, barriers to adherence, and experience of a GFD between groups. METHODS Children <18 years old who had been seen at BC Children's Hospital for T1DCD or CD were invited to participate in a web-based questionnaire and medical record review. RESULTS A total of 26 children with T1DCD and 46 children with CD participated in the study. The groups' demographics and symptoms of CD were similar; however, a greater proportion of those with T1DCD were asymptomatic at diagnosis (T1DCD 27%; CD 7%; P = 0.016). Overall adherence to a GFD was high in both groups (T1DCD 92%; CD 100%; P = 0.38) but those with T1DCD reported a significantly less positive effect on their health (P = 0.006) and a significantly greater negative effect on activities from a GFD (P = 0.03). Children with T1DCD reported more significant barriers to eating gluten-free at home and at restaurants, specifically with social pressure, cost and taste compared to those with CD only. CONCLUSION Children with T1DCD face specific barriers in adherence that are more impactful compared with children living with CD. These children are more often asymptomatic at diagnosis, and they go on to experience different impacts of a GFD spanning across home and social settings. Given the complexity of having a dual diagnosis, CD care should be tailored specifically to children living with T1DCD.
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Affiliation(s)
- Rohan Kakkar
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Fung
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Collin Barker
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Alice Foster
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Brenden E Hursh
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Endocrinology and Diabetes Unit, BC Children’s Hospital, Vancouver, British Columbia, Canada
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Koren D. Growth and development in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2022; 29:57-64. [PMID: 34864760 DOI: 10.1097/med.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature on the subject of linear growth in children and adolescents with or at risk for type 1 diabetes mellitus (T1DM). RECENT FINDINGS Poor glycemic control in T1DM is associated with growth hormone resistance, and improving glycemic control can improve linear growth. Newer reports suggest that the increasingly popular very low carbohydrate diets, may reduce linear growth velocity. SUMMARY Linear growth during childhood is a complex process regulated influenced by genetic, hormonal, nutritional and environmental factors. Linear growth may be impaired in children with T1DM, correlating with poor metabolic control; an extreme example is Mauriac syndrome. This decrement in linear growth appears to be driven in part by a reduction in growth hormone responsiveness, leading to low insulin-like growth factor-1 (IGF-1) levels. Improving glycemic control can lead to improved IGF-1 levels and linear growth. Other factors associated with poor linear growth in T1DM include celiac disease and dietary alterations, with early reports suggesting that very low carbohydrate diets, if not carefully managed, may increase risk of attenuated linear growth. This review examines the latest data regarding the associations between T1DM and linear growth in children.
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Affiliation(s)
- Dorit Koren
- Massachusetts General Hospital Pediatric Endocrine Unit and Harvard University, Boston, Massachusetts, USA
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Taczanowska A, Schwandt A, Amed S, Tóth-Heyn P, Kanaka-Gantenbein C, Volsky SK, Svensson J, Szypowska A. Celiac disease in children with type 1 diabetes varies around the world: An international, cross-sectional study of 57 375 patients from the SWEET registry. J Diabetes 2021; 13:448-457. [PMID: 33118261 DOI: 10.1111/1753-0407.13126] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Children with type 1 diabetes (T1D) are at much higher risk of developing celiac disease (CD) than the general population. The aim of the study was to assess the prevalence and differences in clinical presentation of CD in T1D in different regions of the world. METHODS This study is based on the Better control in Pediatric and Adolescent diabeteS: Working to crEate cEnTers of Reference (SWEET) database. There were 57 375 patients included in the study, aged ≤18 years from 54 SWEET centers. Only centers with screening for celiac disease were included. Regression models adjusted for age, diabetes duration, and gender and a fixed effect in the models for region was used. Diabetes duration, age at diabetes onset, and sex were presented as unadjusted results. RESULTS CD was present in 2652 subjects (4.5%), with different prevalence among regions: from 1.9% in Asia/Middle East to 6.9% in Australia/New Zealand. CD was observed more often among females. Comparing children with and without CD, characteristics for those with CD were younger age at diabetes onset (6.3 [3.3; 9.8] vs 8.1 [4.6; 11.3], P < 0.001) and had longer diabetes duration (6.4 [3.6; 9.8] vs 4.8 [2.1; 8.2], P < 0.001). Further, they had lower glycosylated hemoglobin (HbA1c) in Europe and North America/Canada; lower body mass index (BMI)-SD score (BMI-SDS) in southern Europe, North America, and Canada; In most regions daily insulin dose was lower, height-SDS was lower, and the percentage of insulin pump users was higher in children with T1D and CD. CONCLUSIONS The prevalence and the anthropometric and metabolic consequences of CD in children with T1D differ around the world.
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Affiliation(s)
- Anna Taczanowska
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Péter Tóth-Heyn
- Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Christina Kanaka-Gantenbein
- Agia Sophia Children's Hospital, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sari Krepel Volsky
- Schneider Children's Medical Center of Israel, Endocrinology and Diabetes, Petah Tikva, Israel
| | - Jannet Svensson
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev, Denmark
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Berioli MG, Mancini G, Principi N, Santi E, Ascenzi M, Rogari F, Ceccarini G, Grohmann U, Esposito S. Growth and glycemic control in children with type 1 diabetes and asymptomatic celiac disease treated with a gluten -free diet for 1 year. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219855574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To compare growth and glycemic control in children with type 1 diabetes and silent celiac disease treated with a gluten-free diet for 1 year with those of similar age and gender with type 1 diabetes but without celiac disease, 16 type 1 diabetes patients with silent celiac disease were enrolled and each celiac disease-positive case was matched for age, sex, and duration of diabetes with two type 1 diabetes controls with negative serologic markers of celiac disease. All 16 children with positive celiac disease serology had histologic features consistent with celiac disease despite the absence of symptoms. The mean growth and metabolic control values were similar between children with type 1 diabetes and celiac disease and those with type 1 diabetes but without celiac disease. This study seems to suggest that the early diagnosis of celiac disease and initiation of a gluten-free diet may prevent further deterioration in the nutritional status of children with type 1 diabetes and celiac disease and may reduce the prospect of celiac disease complications without any impact on type 1 diabetes control.
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Affiliation(s)
- Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Giulia Mancini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Nicola Principi
- Professor Emeritus of Pediatrics, Università degli Studi di Milano, Milan, Italy
| | - Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Martina Ascenzi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Francesco Rogari
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Giulia Ceccarini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Ursula Grohmann
- Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Shahramian I, Bazi A, Sargazi A. An Overview of Celiac Disease in Childhood Type 1 Diabetes. Int J Endocrinol Metab 2018; 16:e66801. [PMID: 30214462 PMCID: PMC6119207 DOI: 10.5812/ijem.66801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/09/2018] [Accepted: 06/13/2018] [Indexed: 02/08/2023] Open
Abstract
CONTEXT Celiac disease (CD) is a common phenomenon in children with Type 1 diabetes (T1D). In the present review, we have discussed the pathogenesis, diagnostic biomarkers, risk factors, and prognosis of CD in the context of pediatric T1D. EVIDENCE ACQUISITION Literature published in Web of Science, PubMed, Scopus, Google Scholar, and Cochrane Library were scrutinized up to the end of 2017. The keywords of celiac disease, Type 1 diabetes, children, and pediatric were used in different combinations. RESULTS Immune cytotoxic reactions along with dampen immune regulatory functions contribute to CD in the context of pediatric T1D. Many children with simultaneous CD and T1D do not represent with the clinical signs of the enteropathy rendering a diagnostic challenge. The most common screening tests in these children are routine serological tests of CD, anti - endomysial, anti - transglutaminase, and anti - deamidated gliadin peptide antibodies. Typing for human leukocyte antigens of DQ - 2 and DQ - 8 may assist in the diagnosis of silent CD in children with T1D. The most significant shared non - HLA genetic loci of CD and T1D comprise CTLA - 4, TAGAP, IL - 18RAP, PTPN2, RGS1, SH2B3, CCR5. Interactions between these loci can be important in susceptibility to CD in T1D. Some new biomarkers have been suggested for diagnosis of CD including ischemia-modified albumin (IMA), soluble syndecan-1 (SSDC-1), regenerating gene Iα (REG-Iα), Neurotensin, and Zonulin, which can be useful for diagnosis and screening of CD in childhood T1D. CONCLUSIONS Overall, active seropositive CD seems to be of clinical importance in T1D with significant impacts on the quality of life and predisposition to diabetes associated complications. It is important to detect CD in the context of T1D to prevent potential risks contributing to morbidities and mortalities associated with either CD or T1D.
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Affiliation(s)
- Iraj Shahramian
- Pediatric Ward, Amir - Al - Momenin Hospital, Zabol University of Medical Sciences, Zabol, Iran
| | - Ali Bazi
- Clinical Research Development Unit, Amir - Al - Momenin Hospital, Zabol University of Medical Sciences, Zabol, Iran
- Corresponding author: Ali Bazi, Clinical Research Development Unit, Amir - Al - Momenin Hospital, Zabol University of Medical Sciences, Zabol, Iran. Tel/Fax: +98-5432232166, E-mail:
| | - Alireza Sargazi
- Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran
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Wherrett DK, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S234-S246. [DOI: 10.1016/j.jcjd.2017.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Freeman HJ. Endocrine manifestations in celiac disease. World J Gastroenterol 2016; 22:8472-8479. [PMID: 27784959 PMCID: PMC5064028 DOI: 10.3748/wjg.v22.i38.8472] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/05/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is an autoimmune small intestinal mucosal disorder that often presents with diarrhea, malabsorption and weight loss. Often, one or more associated endocrine disorders may be associated with CD. For this review, methods involved an extensive review of published English-language materials. In children and adolescents, prospective studies have demonstrated a significant relationship to insulin-dependent or type 1 diabetes, whereas in adults, autoimmune forms of thyroid disease, particularly hypothyroidism, may commonly co-exist. In some with CD, multiple glandular endocrinopathies may also occur and complicate the initial presentation of the intestinal disease. In others presenting with an apparent isolated endocrine disorder, serological screening for underlying subclinical CD may prove to be positive, particularly if type 1 diabetes, autoimmune thyroid or other autoimmune endocrine diseases, such as Addison’s disease are first detected. A number of reports have also recorded hypoparathyroidism or hypopituitarism or ovarian failure in CD and these may be improved with a strict gluten-free diet.
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Srivastava A, Chaturvedi S, Dabadghao P, Mathias A, Shukla U, Singh U, Yachha SK. Prevalence of celiac disease in Indian children with type 1 diabetes. Indian J Gastroenterol 2016; 35:372-378. [PMID: 27663711 DOI: 10.1007/s12664-016-0692-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/31/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Type 1 diabetes (T1D) patients are at an increased risk of having celiac disease (CD). We evaluated the prevalence and clinical profile of CD in children and adolescents with T1D and reviewed the Indian literature to determine prevalence and reasons for variability. METHODS In this cross-sectional study, subjects with T1D were prospectively evaluated with a demographic and gastrointestinal (GI) questionnaire, human IgA-tissue transglutaminase (IgA-tTGA), and endoscopic duodenal biopsy in serology positive patients. Studies evaluating prevalence of CD in T1D from India were reviewed. RESULTS Fourteen (13.6 %) of the 103 (52 boys, 13 years [2-20]) T1D patients were IgA-tTGA (182 U [47-300]) positive and 3.8 % (4/103) had villous atrophy on histology. Subjects with T1D and CD (n = 4) were younger at onset of T1D (32.5 ± 12.6 vs. 110.5 ± 53.8 months; p < 0.005) and more often had GI symptoms (pain abdomen [2/4 vs. 6/89; p = 0.01], stool frequency of 2-3/day [3/4 vs. 38/89; p = 0.004]) than screen negative T1D (n = 89). Growth and glycemic control were not different between the groups. In the 7 Indian studies involving 915 children and adults, 13.8 % (8 % to 17.8 %) T1D were serology positive. Prevalence of CD was reported as 6.9 % (2.3 % to 11.1 %), but only 3.1 % (2.3 % to 4.2 %) had villous atrophy on histology. CONCLUSIONS Potential CD and CD were present in 13.6 % and 3.8 % children with T1D respectively. T1D with CD have onset of diabetes at younger age and were more often symptomatic than screen negative T1D.
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Affiliation(s)
- Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
| | - Saurabh Chaturvedi
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Amrita Mathias
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Umesh Shukla
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Uttam Singh
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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The Role of Gluten in Celiac Disease and Type 1 Diabetes. Nutrients 2015; 7:7143-62. [PMID: 26343710 PMCID: PMC4586524 DOI: 10.3390/nu7095329] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/14/2022] Open
Abstract
Celiac disease (CD) and type 1 diabetes (T1D) are autoimmune conditions in which dietary gluten has been proven or suggested to play a pathogenic role. In CD; gluten is established as the instigator of autoimmunity; the autoimmune process is halted by removing gluten from the diet; which allows for resolution of celiac autoimmune enteropathy and subsequent normalization of serological markers of the disease. However; an analogous causative agent has not yet been identified for T1D. Nevertheless; the role of dietary gluten in development of T1D and the potentially beneficial effect of removing gluten from the diet of patients with T1D are still debated. In this review; we discuss the comorbid occurrence of CD and T1D and explore current evidences for the specific role of gluten in both conditions; specifically focusing on current evidence on the effect of gluten on the immune system and the gut microbiota.
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Akirov A, Pinhas-Hamiel O. Co-occurrence of type 1 diabetes mellitus and celiac disease. World J Diabetes 2015; 6:707-14. [PMID: 26069719 PMCID: PMC4458499 DOI: 10.4239/wjd.v6.i5.707] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/30/2014] [Accepted: 03/16/2015] [Indexed: 02/05/2023] Open
Abstract
The co-occurrence of celiac disease (CD) and type 1 diabetes (T1DM) has been reported as 5-7 times more prevalent than CD alone. The clinical presentation and natural history of CD in patients with T1DM may vary considerably. Less than 10% of patients with T1DM and CD show gastrointestinal symptoms. Therefore, experts support screening for CD in T1DM patients, though there is no consensus as to the recommended frequency of screening. When stratified by time since CD diagnosis, longer follow-up and coexistence of CD are associated with significant increased risk of diabetic associated morbidity and mortality. Early CD diagnosis and treatment with a gluten-free diet are essential.
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