Differences in metabolic variables between adult coeliac patients at diagnosis and patients on a gluten-free diet

The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a systematic review and meta-analysis

BACKGROUND

This study aimed to estimate the prevalence of obesity, overweight, and underweight in celiac disease (CD) at diagnosis before starting the Gluten-free diet (GFD).

METHODS

A comprehensive search was conducted in PubMed, Embase, Scopus, and Web of Science until July 2024 to find the cross-sectional and longitudinal studies that measured the body mass index (BMI) in CD patients at diagnosis. The risk of bias assessment was conducted using the Newcastle-Ottawa Quality Assessment scale. Meta-regression analyses were applied to understand whether weight status is associated with CD.

RESULTS

A total of 23 studies involving 15,299 CD patients and 815,167 healthy individuals were included in this study. In newly diagnosed CD patients, pooled estimates of the prevalence of obesity, overweight, and underweight before GFD were 11.78%, 18.42%, and 11.04%, respectively. The prevalence of overweight and obesity in newly diagnosed CD patients increased from 22.15% in 2003-2009 to 32.51% in 2016-2021. Meta-regression analyses indicated that the CD patients with higher BMI had a higher mean age (p = 0.001), and female gender had a marginally significant (p = 0.055) association with higher BMI. Only a few CD patients were underweight at the time of diagnosis, and more patients were overweight/obese.

CONCLUSIONS

our meta-analysis demonstrated that only a few CD patients were underweight at the time of diagnosis, and almost 37% were overweight or obese. Meta-regression showed a significant association between higher BMI and higher mean age and female gender. A delay or failure for diagnosis of CD is more common in overweight/obese patients, resulting in more progression of the disease and counteracting any advantages of diagnosis.

Sorghum (Sorghum vulgare): an ancient grain, a novel choice for a healthy gluten-free diet

Celiac disease (CD) is an autoimmune disease related to gluten consumption. To date, the only effective therapy that can reverse symptoms and prevent complications is the gluten-free diet (GFD), which is challenging to maintain and has potential health risks. Identifying foods that can help diversify the GFD and that best match the nutritional needs of people with CD may improve the health and quality of life of celiac patients. This review, conducted through a non-systematic search of the available literature, aims to gather the most recent research on nutritional issues in CD and GFD. Moreover, it highlights how sorghum characteristics could provide health benefits to CD patients that counteract the nutritional problems due to CD and the nutritional consequences of GFD acceptance. Sorghum contains a wide variety of bioactive compounds, such as flavones and tannins, that have shown anti-inflammatory activity in preclinical studies. They can also regulate blood sugar levels and lower cholesterol to reduce the effects of common chronic diseases such as metabolic and cardiovascular diseases. Because it is gluten-free, its use in making foods for celiac patients is increasing, especially in the United States. In conclusion, sorghum is a fascinating grain with nutritional properties and health benefits for supplementing GFD. However, only one study confirms the short-term safety of sorghum inclusion in the GFD, and further long-term studies with a large sample are needed.

Nutrition Assessment and Management in Celiac Disease

Celiac disease (CeD) is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive and, like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is also associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity and metabolic complications, such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality at diagnosis and while on a long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a GFD.

Nutritional Status and Metabolism in Celiac Disease: Narrative Review

This review summarizes findings from studies assessing the nutritional status of patients with celiac disease (CD). Malnutrition, including over- and undernutrition, may be present in CD, both at diagnosis and while under treatment. Underweight and growth retardation in children, which mostly reflect malabsorption as a consequence of intestinal inflammation, are not a rule. Clinical presentations of CD can vary widely, and each manifestation has its own characteristics. Evaluating various nutritional parameters can be beneficial for CD patients and may improve health outcomes by facilitating an accurate definition of dietary needs and the development of a balanced diet that not only focuses on eliminating gluten but also provides adequate nutrients, alters metabolism, and reduces the risk of other disorders developing. The cornerstone of CD therapy is a gluten-free diet (GFD), which improves nutritional status, but even on a GFD, features of malnutrition may be present. Additionally, overweight and obesity may occur in patients on a GFD, with typical metabolic consequences.

Assessment of Nutritional Status by Bioelectrical Impedance in Adult Patients with Celiac Disease: A Prospective Single-Center Study

The gluten-free diet [GFD] has been linked to an increased risk of weight gain and the development of metabolic disorders. Most of the studies have focused on the effect of GFD on the Body Mass Index [BMI]. We aimed to evaluate the nutritional status using specific nutritional parameters in patients with celiac disease [CeD] at diagnosis and on a GFD compared to healthy controls. We recruited subjects at our outpatient clinic at the University of Padua. We collected demographic and clinical data and values obtained with bioelectrical impedance analysis. A total of 24 CeD patients and 28 healthy controls were enrolled. CeD patients at diagnosis had a lower body cell mass index [BCMI, p = 0.006], fat-free mass index [FFMI, p = 0.02], appendicular skeletal muscle index [ASMI, p = 0.02], and phase angle [PA] [p < 0.001] compared to controls. Their percentage of extracellular water [ECW] was also higher [p < 0.001]. Considering CeD patients after GFD, nutritional status significantly improved after 6 months of GFD. We did not observe differences in BMI among groups [p = ns]. CeD patients at diagnosis were found to have a poorer nutritional status than healthy controls, with a positive effect of the GFD on their nutritional status, underlining the inefficacy of evaluating this aspect through only BMI evaluation.

Application of a Platform for Gluten-Free Diet Evaluation and Dietary Advice: From Theory to Practice

The present work aimed to analyze, through the GlutenFreeDiet digital platform, the evolution over one year of the nutritional status, dietary profile and symptoms present among celiac people on a gluten-free diet (GFD) while receiving individualized dietary advice. Twenty-seven adults and thirty-one celiac children/adolescents participated in the study. This was then followed up by three visits, at diagnosis, and after 3 and 12 months (vt0, vt3 and vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires. All patients received written personalized dietary advice from dietitians who interpreted data from the platform. Results obtained indicated that participants consumed proteins and lipids in excess and carbohydrates in defect. Low intakes of cereals, fruit and vegetables and high meat intakes were observed. However, gluten-free product (GFP) consumption and that of ultra-processed foods was reduced after 1 year in adults. Symptoms decreased after vt3 but recurred in vt12. Changes in ultra-processed foods and GFP intake, but lack of changes in the rest of the parameters suggested that the platform support was not effective enough. Even though the platform represents a useful tool for monitoring celiac patients and giving dietary advice, modules that require more continuous attention and nutritional education of patients should be provided for interventions to be more effective.

It Is High Time for Personalized Dietary Counseling in Celiac Disease: A Systematic Review and Meta-Analysis on Body Composition

The body composition of patients with celiac disease (CD), on which the effects of a gluten-free diet (GFD) are controversial, differs from that of the average population. In this study, we aimed to compare the body composition across CD patients before a GFD, CD patients after a one-year GFD and non-celiac control subjects. A systematic search was conducted using five electronic databases up to 15 July 2021 for studies that reported at least one of the pre-specified outcomes. In meta-analyses, weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. A total of 25 studies were eligible for systematic review, seven of which were included in meta-analysis. During a ≥1-year GFD, fat mass of CD patients, compared to that at baseline, significantly increased (WMD = 4.1 kg, 95% CI = 1.5 to 6.6, three studies). In CD patients after a ≥1-year GFD, compared to non-celiac controls, fat mass (WMD = -5.8 kg, 95% CI = -8.7 to -2.9, three studies) and fat-free mass (WMD = -1.9 kg, 95% CI = -3.0 to -0.7, three studies) were significantly lower. In conclusion, body composition-related parameters of CD patients differ from that of the non-celiac control subjects even after a longstanding GFD.

Anxiety Symptoms in Adult Celiac Patients and the Effect of a Gluten-Free Diet: An Iranian Nationwide Study

Introduction

Psychiatric disorders, especially anxiety, are considered extraintestinal manifestations of celiac disease (CD).

Objective

This study aims to evaluate the level of anxiety in treated patients with CD in Iran.

Methods

A total of 283 CD patients (190 female, 93 male) were enrolled in a study during 2016-2018 from 9 centers in Iran. The Zung Self-Rating Anxiety Scale questionnaire was completed. The anxiety index was calculated. Also, demographic data and the duration of treatment with a gluten-free diet (GFD) were recorded. Data were analyzed by SPSS version 20.

Results

Anxiety symptoms were reported in 67.8% of patients. Female patients had a higher anxiety index than male patients. Duration of treatment with a GFD did not influence the anxiety index (17.3% were on a GFD for <1 year, 33.6% for 1-2 years, and 49.1% had GFD for >2 years; p = 0.86).

Conclusions

These results suggest that anxiety symptoms are common among patients, especially females, with CD in Iran and GFD duration has no effect on their improvement.

New Software for Gluten-Free Diet Evaluation and Nutritional Education

Following a gluten-free diet (GFD) is the only treatment for celiac disease. This diet must ensure the absence of gluten but also needs to be nutritionally balanced. Dietitians working in this field cannot properly evaluate energy and nutrient intake of celiac people because dietary programs available on the market do not contain the nutritional composition of gluten-free products (GFP). Here we present a new GFD evaluation software that contains more than 700 gluten-free rendered foodstuffs and their macronutrient composition. Apart from diet evaluation and design, the software represents a tool for nutritional education as well, since it shows diet appropriacy and indicates how to promote balanced self-care. Moreover, anthropometric and biochemical data or symptoms presence and diet adherence can be recorded and evaluated. This open free software, can be downloaded in its app format for mobiles and tablets. Software evaluation indicated its correct functionality and the importance of assessing a GFD with GFP instead of with their gluten-containing analogues. Thus, this software represents an essential e-Health tool, not only for proper GFD evaluation, but also for improving life quality of celiac and gluten sensitive people.

Celiac Male's Gluten-Free Diet Profile: Comparison to that of the Control Population and Celiac Women

The aim of the present work was to analyze the body composition and dietary profile of Spanish celiac men and to compare them to control men and celiac women from our previous studies. Forty-two celiac men (31.5 ± 11.9 years) were recruited and anthropometric measurements were taken. Analysis of energy consumption, macro- and micronutrient intake and food frequency consumption was carried out. Celiac men were more overweight and obese than celiac women, but less than the control population, reporting the same energy intake and macronutrient distribution. Most micronutrient deficiencies in celiac men were not directly related to a gluten free diet; these were also observed for the entire population. The least adherence to Dietary Reference Intakes in women was reported for iron, iodine, potassium and selenium, whereas magnesium intake was higher than in men. Among celiac participants (both genders), cereal, vegetable and legume consumption was poor and meat intake was contrastingly excessive. In conclusion, the dietary profile of celiac men is as unbalanced as that of control men but slightly more than that of celiac women. General nutritional education should be given to both general and celiac populations, and specific advices to celiac men, in order to decrease the risk of celiac disease-related pathologies.

DHA serum levels were significantly higher in celiac disease patients compared to healthy controls and were unrelated to depression

Objectives

Celiac disease (CD), a genetically predisposed intolerance for gluten, is associated with an increased risk of major depressive disorder (MDD). We investigated whether dietary intake and serum levels of the essential n-3 polyunsaturated fatty acids (PUFA) eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) found in fatty fish play a role in this association.

Methods

Cross-sectional study in 71 adult CD patients and 31 healthy volunteers, matched on age, gender and level of education, who were not using n-3 PUFA supplements. Dietary intake, as assessed using a 203-item food frequency questionnaire, and serum levels of EPA and DHA were compared in analyses of covariance, adjusting for potential confounders. Serum PUFA were determined using gas chromatography.

Results

Mean serum DHA was significantly higher in CD patients (1.72 mass%) than controls (1.28 mass%) after multivariable adjustment (mean diff. 0.45 mass%; 95% CI: 0.22–0.68; p = 0.001). The mean intake of EPA plus DHA did not differ between CD patients and controls after multivariable adjustment (0.15 and 0.22 g/d, respectively; p = 0.10). There were no significant differences in intake or serum levels of EPA and DHA between any of the CD patient groups (never depressed, current MDD, minor/partially remitted MDD, remitted MDD) and controls.

Conclusions

Patients on a long term gluten-free diet had similar intakes of EPA plus DHA compared to controls. Contrary to expectations, DHA serum levels were significantly higher in CD patients compared to healthy controls and were unrelated to MDD status.

The metabonomic signature of celiac disease

Celiac disease (CD) is a multifactorial disorder involving genetic and environmental factors, thus, having great potential impact on metabolism. This study aims at defining the metabolic signature of CD through Nuclear Magnetic Resonance (NMR) of urine and serum samples of CD patients. Thirty-four CD patients at diagnosis and 34 healthy controls were examined by (1)H NMR of their serum and urine. A CD patients' subgroup was also examined after a gluten-free diet (GFD). Projection to Latent Structures provided data reduction and clustering, and Support Vector Machines provided pattern recognition and classification. The classification accuracy of CD and healthy control groups was 79.7-83.4% for serum and 69.3% for urine. Sera of CD patients were characterized by lower levels (P < 0.01) of several metabolites such as amino acids, lipids, pyruvate and choline, and by higher levels of glucose and 3-hydroxybutyric acid, while urines showed altered levels (P < 0.05) of, among others, indoxyl sulfate, meta-[hydroxyphenyl]propionic acid and phenylacetylglycine. After 12 months of GFD, all but one of the patients were classified as healthy by the same statistical analysis. NMR thus reveals a characteristic metabolic signature of celiac disease. Altered serum levels of glucose and ketonic bodies suggest alterations of energy metabolism, while the urine data point to alterations of gut microbiota. Metabolomics may thus provide further hints on the biochemistry of the disease.

Effects of binge eating behavior on fuel oxidation and body composition

OBJECTIVE

To investigate energy expenditure and glucose metabolism after a standard oral glucose load (75 g) in 8 normal weight bulimic women and 8 normal weight control women and to evaluate the relative endocrine implication.

DESIGN

Serum glucose and insulin were measured both in basal conditions and after the glucose load; a basal endocrine assessment and body composition was evaluated and glucose induced thermogenesis (GIT) was calculated during 300 min following the glucose load.

RESULTS

Serum glucose levels were significantly lower in bulimics both in fasting and in post-prandial state. Insulin levels were similar in bulimic and control women before and after the glucose load. FSH, leptin and free urinary cortisol (FUC) were all within the normal ranges, but significantly lower in bulimic patients compared with controls (p < 0.001). Fat mass (FM) and Fat-free mass (FFM) were reduced in bulimic patients, even if they normalized after correction per body weight. Resting energy expenditure (REE) was similar in the two groups even after FFM normalization, while GIT was lower in bulimic patients and it was strongly related to free urinary chortisol. Glucose oxidation was higher in fasting state and post glucose load, while lipid oxidation was strongly reduced.

CONCLUSION

An energy preservation mechanism seems to be the key element for normal-weight bulimic patients' metabolism, consisting in leptin levels and GIT reduction, and lipid oxidation inhibition.

Reduced plasma ghrelin concentration in celiac disease after gluten-free diet treatment

OBJECTIVE

Celiac disease (CD) is characterized by malabsorption, weight loss and increased energy expenditure. The aim of this study was to investigate the relationship between circulating ghrelin and leptin, which are produced at gastrointestinal level and are involved in energy balance regulation, and changes in body composition and energy metabolism in CD patients before and after gluten-free diet (GFD)-induced restoration of the intestinal mucosa.

MATERIAL AND METHODS

Body composition (by dual-energy X-ray absorptiometry), resting metabolic rate and substrate oxidation rates (by indirect calorimetry) were assessed in 18 adult women with the classic form of CD (age 31.4 +/- 7.8 years, body mass index (BMI) 20.6 +/- 2.1 kg/m2) before and at least 2 years after GFD treatment and in 22 age-matched healthy women (age 33.1 +/- 7.2 years, BMI 22.9 +/- 2.1 kg/m2). Plasma leptin and ghrelin concentrations were assessed by the ELISA and RIA procedures, respectively.

RESULTS

Fat-free mass was reduced before and after GFD compared to control subjects (p < 0.01), while fat mass increased after treatment (p < 0.01). Plasma leptin concentration was similar between groups and correlated only with BMI (r = 0.84; p < 0.0001) and percentage body fat (r = 0.86; p < 0.0001). Circulating ghrelin levels (pg/ml) were similar between untreated patients and control subjects, but decreased after GFD treatment (untreated CD: 282.6 +/- 55.5 versus treated 109.2 +/- 49.9; p < 0.0001 and versus control subjects 262.2 +/- 30.0; p < 0.0001) and were negatively correlated with BMI in CD patients (r = -0.32; p < 0.01).

CONCLUSIONS

The low plasma ghrelin concentration found in CD patients after GFD treatment could only be partially explained by the slight increase in body-weight and fat mass. Further studies are needed to better ascertain the role played by an incomplete functional or quantitative recovery of ghrelin-producing cells in CD.

Psychological support counselling improves gluten-free diet compliance in coeliac patients with affective disorders

BACKGROUND

Anxiety and depression are common features of coeliac disease. Depression is cause of non-compliance to treatment in chronic illness.

AIM

To evaluate the useful of psychological support counselling to improve affective disorders and gluten-free diet adherence in coeliac disease with anxiety and depression.

METHODS

A total of 66 coeliac disease patients with state anxiety and current depression were enrolled. Patients were randomized in two groups: in group A psychological support was started at the beginning of gluten-free diet, while group B was free of psychological support. Both groups were followed every 2 weeks for 6 months. State and Trait Anxiety Inventory test Y-1 and the modified Zung self-rating depression scale were administered before (T0) and after 6 months of gluten-free diet (T1).

RESULTS

At T1 no difference was found between groups in the percentage of state anxiety, while a significant lower percentage of depressed subjects was found in group A with respect to group B (15.1% vs. 78.8%; P=0.001). In the follow-up period, a significant lower compliance to gluten-free diet was found in group B with respect to group A (39.4% vs. 9.1%; P=0.02).

CONCLUSIONS

In coeliac disease patients with affective disorders psychological support seems to be able to reduce depression and to increase gluten-free diet compliance.

Regional cerebral hypoperfusion in patients with celiac disease

BACKGROUND

Neurological and psychiatric disorders occur in approximately 10% of patients with celiac disease. Although some of these alterations respond to a gluten-free diet, the etiology of these abnormalities is uncertain. Because of a case report that cerebral hypoperfusion in a celiac patient resolved after a gluten-free diet, we studied brain perfusion changes in untreated celiac patients, treated celiac patients, and healthy controls.

METHODS

A total of 15 untreated celiac patients without conditions affecting brain perfusion were enrolled; none had neurological or psychiatric disorders other than anxiety or depression. We also studied 15 celiac patients who were on a gluten-free diet for almost 1 year, and 24 healthy volunteers of similar sex and age. All subjects underwent cerebral single photon emission computed tomography examination.

RESULTS

Of the 15 untreated celiac patients, 11 (73%) had at least one hypoperfused brain region, compared with only 1 (7%) of the 15 celiac patients on a gluten-free diet and none of the controls (P = 0.01). Cerebral perfusion was significantly lower (P <0.05) in untreated celiac patients, compared with healthy controls, in 7 of 26 brain regions. No significant differences in cerebral perfusion were found between celiac patients on a gluten-free diet and healthy controls.

CONCLUSION

There is evidence of regional cerebral blood flow alteration in untreated celiac patients.

Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study

BACKGROUND

A high prevalence of anxiety and depression has been reported in untreated coeliac disease (CD) patients. At present, the role of a gluten-free diet (GFD) on psychological disorders is still poorly known. The aim of this study was to evaluate state and trait anxiety and depression in adult CD patients before and after 1 year of GFD.

METHODS

A total of 35 CD patients were studied before and after 1 year of GFD. A total of 59 healthy subjects matched for gender, age and socio-economic status were studied as a control group. State and trait anxiety were assessed with the STAI test; depression was assessed using the modified version of the SDS Zung self-rating depression scale (M-SDS). The tests were administered before (TO) and after 1 year of GFD (T1).

RESULTS

At T0, CD patients showed high levels of state anxiety in a significantly higher percentage compared to controls (71.4% versus 23.7%; P < 0.0001), while there was no significant difference in trait anxiety between groups (25.7% versus 15.2%; P:ns); the percentage of subjects with depression was significantly higher in the CD group than in the control group (57.1% versus 9.6%; P < 0.0001). At T1, a significant decrease in the percentage of state anxiety was found in CD patients (T0: 71.4% versus T1: 25.7%; P < 0.001), while there were no significant changes in the percentage of trait anxiety (T0: 25.7% versus T1: 17.1%; P:ns) or depression (T0: 57.1.% versus T1: 45.7%; P:ns), which was still present in a significantly higher percentage in treated CD compared to controls (P < 0.0001).

CONCLUSION

In CD patients anxiety is present in a predominantly reactive form and it decreases after GFD. Depression is present in a higher percentage in CD patients and 1 year of GFD fails significantly to affect depressive symptoms. The presence of depression after GFD could be related to the reduction in quality of life in CD patients. The non-regression of depression after GFD could suggest that these patients need psychological support.

Changes in body composition, substrate oxidation, and resting metabolic rate in adult celiac disease patients after a 1-y gluten-free diet treatment

BACKGROUND

The incidence of celiac disease has been on the rise in both Europe and the United States. Celiac disease patients are at high risk of undernutrition because of nutrient malabsorption.

OBJECTIVE

The aim of the present study was to evaluate changes in body composition and energy metabolism in a group of patients with celiac disease before and after consumption of a gluten-free diet (GFD).

DESIGN

Body composition (by anthropometry and isotopic dilution), resting metabolic rate (RMR), and substrate oxidation rates (by indirect calorimetry) were assessed in 39 adult celiac disease patients (16 men and 23 women) with a mean (+/-SD) age of 29. 9 +/- 7.6 y, weight of 58.3 +/- 6.6 kg, and percentage body fat of 20.1 +/- 6.7%, and in 63 (29 men and 34 women) age- and height-matched control subjects (age: 33.2 +/- 8.1 y; weight: 66.8 +/- 6.6 kg; and percentage body fat: 25.4 +/- 3.7%). Celiac disease patients were studied twice, at diagnosis and 1 y after treatment with a GFD.

RESULTS

Before treatment, celiac disease patients had a lower body weight (P < 0.05) and a higher carbohydrate oxidation rate (P < 0.01) than did control subjects. Carbohydrate oxidation rates correlated positively with fecal lipid loss in untreated celiac disease patients (r = 0.80, P < 0.0001). After the GFD, percentage body fat was higher in celiac disease patients than in control subjects (P < 0.01), and lipid intakes tended to be higher than before treatment.

CONCLUSIONS

This longitudinal study showed that the GFD treatment significantly increased body fat stores. Untreated patients preferentially utilized carbohydrates as a fuel substrate, probably as a consequence of both lipid malabsorption and a high carbohydrate intake, and lipid utilization increased with the restoration of the intestinal mucosa.

Body composition in children with celiac disease and the effects of a gluten-free diet: a prospective case-control study

BACKGROUND

Celiac disease is the most common cause of malnutrition in children of Western countries.

OBJECTIVE

The objective was to measure body composition in children at the time celiac disease was diagnosed and after consumption of a gluten-free diet (GFD).

DESIGN

We assessed body composition by dual-energy X-ray absorptiometry in 29 children and adolescents with a mean (+/-SD) age of 9.5 +/- 3.4 y at the time celiac disease was diagnosed and in a subset of 20 patients after 1.2 +/- 0.2 y of a GFD. We also studied 23 patients aged 21.2 +/- 4.6 y who consumed a GFD for 10.6 +/- 4.5 y. Each patient was matched with a healthy control subject of the same age and sex.

RESULTS

Untreated patients weighed less than control subjects (P = 0.04). Fat mass and bone mineral content were lower in the patients than in the control subjects (P < 0.01), as was lean mass of the limbs (P = 0.0013). After approximately 1 y of the GFD, there were no significant differences in body-composition values between patients and control subjects. Similarly, body-composition values of celiac disease patients who consumed the GFD long term were comparable with those of healthy subjects.

CONCLUSIONS

Remarkable abnormalities in body composition were found in children at the time of diagnosis of celiac disease. Appropriate dietary treatment reverses body-composition abnormalities quickly and the beneficial effects of gluten withdrawal are persistent. Because these results are harder to achieve if celiac disease is first diagnosed in adulthood, efforts to encourage early diagnosis of celiac disease should be made.

Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten

BACKGROUND

It is expected that in patients with coeliac disease the small-bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in 'gluten-free' foods, as defined by the WHO/FAO Codex Alimentarius.

METHODS

Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet.

RESULTS

In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet: 50 patients). Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal. However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS).

CONCLUSION

The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.