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Stefanolo JP, Temprano MDLP, Smecuol E, Puebla R, Portillo JD, Niveloni S, Verdú EF, Bai JC. Comparison of weekly gluten immunogenic peptide measurement and conventional tools to assess adherence to the gluten-free diet in celiac disease: An observational prospective study. Am J Clin Nutr 2023; 118:1106-1112. [PMID: 37806557 DOI: 10.1016/j.ajcnut.2023.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Adherence to the gluten-free diet (GFD) is critical to achieving symptom control and mucosal healing in celiac disease (CeD), but its assessment is difficult. OBJECTIVES We sought to compare stool gluten immunogenic peptides (GIPs) measurements over a 4-wk period with conventional tools commonly used to monitor compliance with a GFD. METHODS Consecutive adult patients with CeD attending the Small Bowel Section of the Buenos Aires Gastroenterology Hospital were invited to this observational study and were instructed to collect stool samples on Fridays for 4 consecutive weeks. Weekly mean stool GIP concentration was measured was estimated. GIP results were compared with a self-assessment scale of adherence, specific CeD serology, the celiac symptom index, and the assessment by an expert dietitian. RESULTS Fifty-three CeD patients were enrolled and those with stool GIP ≥0.65 μg/g/wk (n = 13; 24.5%) had higher serum concentrations of IgA deamidated gliadin peptides (DGPs) antibodies [69 (29-109) compared with 14 (13-29); P = 0.0005] and IgA tissue transglutaminase [42 (14-200) compared with 10 (7-16); P = 0.02], higher proportion of cases with IgA DGP antibodies >20 AU/mL (84.6% compared with 33.3%; P = 0.002), and a higher self-estimated adherence score [5 (4-9) compared with 9 (7-10); P = 0.003]. GIP did not correlate with celiac symptom index scores (55.6% compared with 30.8%; P = 0.9). Expert dietitian assessment identified 69% [odds ratio (OR): 5.25; 95% CI: 1.1-27.2; P = 0.01] of nonadherent cases when high stool GIP. Logistic regression analysis determined that IgA DGP (adjusted OR: 1.1; 95% CI: 1.01-1.11; P = 0.02) and males (adjusted OR: 28.3; 95% CI: 1.1-722.6; P = 0.04) were independently associated with excessive gluten exposure. CONCLUSIONS Weekly stool GIP identifies gluten exposure that is not always detected by commonly used GFD adherence assessment methods. The higher the concentration of stool GIP, the better the predictive value of serology and dietitian interviews. Stool GIP is a useful and practical test for GFD monitoring, particularly for risky gluten exposure in real-life scenarios.
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Affiliation(s)
- Juan P Stefanolo
- Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | | | - Edgardo Smecuol
- Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Roberto Puebla
- Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | | | - Sonia Niveloni
- Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Elena F Verdú
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Julio C Bai
- Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina; Research Institutes, Universidad del Salvador, Buenos Aires, Argentina.
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Zhen J, Stefanolo JP, Temprano MDLP, Seiler CL, Caminero A, de-Madaria E, Huguet MM, Santiago V, Niveloni SI, Smecuol EG, Dominguez LU, Trucco E, Lopez V, Olano C, Mansueto P, Carroccio A, Green PH, Duerksen D, Day AS, Tye-Din JA, Bai JC, Ciacci C, Verdú EF, Lebwohl B, Pinto-Sanchez MI. Risk perception and knowledge of COVID-19 in patients with celiac disease. World J Gastroenterol 2021; 27:1213-1225. [PMID: 33828395 PMCID: PMC8006100 DOI: 10.3748/wjg.v27.i12.1213] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We recently demonstrated that the odds of contracting coronavirus disease 2019 (COVID-19) in patients with celiac disease (CeD) is similar to that of the general population. However, how patients with CeD perceive their COVID-19 risk may differ from their actual risk.
AIM To investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their perception.
METHODS We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics, diet, COVID-19 testing, and risk perceptions of COVID-19 in patients with CeD. Participants were recruited through various celiac associations, clinic visits, and social media. Risk perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general population. Logistic regression was used to determine the influencing factors associated with COVID-19 risk perception, such as age, sex, adherence to a gluten-free diet (GFD), and comorbidities such as cardiac conditions, respiratory conditions, and diabetes. Data was presented as adjusted odds ratios (aORs)
RESULTS A total of 10737 participants with CeD completed the survey. From them, 6019 (56.1%) patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population. A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD (56.1% vs 26.7%, P < 0.0001). Consequently, 34.8% reported taking extra COVID-19 precautions as a result of their CeD. Members of celiac associations were less likely to perceive an increased risk of COVID-19 when compared to non-members (49.5% vs 57.4%, P < 0.0001). Older age (aOR: 0.99; 95%CI: 0.99 to 0.99, P < 0.001), male sex (aOR: 0.84; 95%CI: 0.76 to 0.93, P = 0.001), and strict adherence to a GFD (aOR: 0.89; 95%CI: 0.82 to 0.96, P = 0.007) were associated with a lower perception of COVID-19 risk and the presence of comorbidities was associated with a higher perception of COVID-19 risk (aOR: 1.38; 95%CI: 1.22 to 1.54, P < 0.001).
CONCLUSION Overall, high levels of risk perceptions, such as those found in patients with CeD, may increase an individual’s pandemic-related stress and contribute to negative mental health consequences. Therefore, it is encouraged that public health officials maintain consistent communication with the public and healthcare providers with the celiac community. Future studies specifically evaluating mental health in CeD could help determine the consequences of increased risk perceptions in this population.
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Affiliation(s)
- Jamie Zhen
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
| | - Juan Pablo Stefanolo
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - María de la Paz Temprano
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Caroline L Seiler
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
| | - Alberto Caminero
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
| | - Enrique de-Madaria
- Department of Pancreatic Unit, Hospital General Universitario de Alicante, Alicante 03010, Spain
| | - Miguel Montoro Huguet
- Department of Medicine, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza 50009, Spain
- Department of Medicine, Hospital Universitario San Jorge. Huesca, Zaragoza 50004, Spain
| | - Vivas Santiago
- Department of Gastroenterology, Univ Hosp Leon, Gastroenterol Unit, Altos de Nava S-N, Leon 24071, Spain
| | - Sonia Isabel Niveloni
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Edgardo Gustavo Smecuol
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Luis Uzcanga Dominguez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF 14080, Mexico
| | - Elena Trucco
- Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
| | - Virginia Lopez
- Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
| | - Carolina Olano
- Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
| | - Pasquale Mansueto
- Department of Internal Medicine, PROMISE Department, University of Palermo, Palermo 90127, Italy
| | - Antonio Carroccio
- Department of Internal Medicine, V. Cervello Hospital, PROMISE Department, University of Palermo, Palermo 90127, Italy
| | - Peter H Green
- Celiac Disease Center, Columbia University Medical Center, Columbia Univ, Celiac Dis Ctr, Div Digest and Liver Dis, New York, NY 10032, United States
| | - Donald Duerksen
- Department of Medicine, St Boniface Gen Hosp, University of Manitoba, Winnipeg R2H 2A6, Canada
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch 8041, New Zealand
| | - Jason A Tye-Din
- Department of Gastroenterology, Royal Melbourne Hospital, Immunology Division, Walter and Eliza Hall Institute, Melbourne 3052, Australia
| | - Julio César Bai
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentry, Scuola Medica Salernitana, University of Salerno, Celiac Center at the University Hospital San Giovanni di Dio e Ruggi di Aragona, Salerno 84131, Italy
| | - Elena F Verdú
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton L8S4K1, ON, Canada
| | - Benjamin Lebwohl
- The Celiac Disease Center, Columbia University, New York, NY 10032, United States
| | - M Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton L8S4K1, ON, Canada
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Stefanolo JP, Tálamo M, Dodds S, de la Paz Temprano M, Costa AF, Moreno ML, Pinto-Sánchez MI, Smecuol E, Vázquez H, Gonzalez A, Niveloni SI, Mauriño E, Verdu EF, Bai JC. Real-World Gluten Exposure in Patients With Celiac Disease on Gluten-Free Diets, Determined From Gliadin Immunogenic Peptides in Urine and Fecal Samples. Clin Gastroenterol Hepatol 2021; 19:484-491.e1. [PMID: 32217152 DOI: 10.1016/j.cgh.2020.03.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is not clear how often patients who are on gluten-free diets (GFDs) for treatment of celiac disease still are exposed to gluten. We studied levels of gluten immunogenic peptides (GIP) in fecal and urine samples, collected over 4 weeks, from patients with celiac disease on a long-term GFD. METHODS We performed a prospective study of 53 adults with celiac disease who had been on a GFD for more than 2 years (median duration, 8 y; interquartile range, 5-12 y) in Argentina. At baseline, symptoms were assessed by the celiac symptom index questionnaire. Patients collected stool each Friday and Saturday and urine samples each Sunday for 4 weeks. We used a commercial enzyme-linked immunosorbent assay to measure GIP in stool and point-of-care tests to measure GIP in urine samples. RESULTS Overall, 159 of 420 stool and urine samples (37.9%) were positive for GIP; 88.7% of patients had at least 1 fecal or urine sample that was positive for GIP (median, 3 excretions). On weekends (urine samples), 69.8% of patients excreted GIP at least once, compared with 62.3% during weekdays (stool). The number of patients with a sample that was positive for GIP increased over the 4-week study period (urine samples in week 1 vs week 4: P < .05). Patients with symptoms had more weeks in which GIP was detected in stool than patients without symptoms (P < .05). The number of samples that were positive for GIP correlated with titers of deamidated gliadin peptide IgA in patients' blood samples, but not with levels of tissue transglutaminase. CONCLUSIONS Patients with celiac disease on a long-term GFD still frequently are exposed to gluten. Assays to detect GIP in stool and urine might be used to assist dietitians in assessment of GFD compliance.
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Affiliation(s)
| | - Martín Tálamo
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Samanta Dodds
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | | | | | - María Laura Moreno
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - María Inés Pinto-Sánchez
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Centre, Health Sciences, Hamilton, Ontario, Canada
| | - Edgardo Smecuol
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Horacio Vázquez
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Andrea Gonzalez
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | | | - Eduardo Mauriño
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Elena F Verdu
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Centre, Health Sciences, Hamilton, Ontario, Canada
| | - Julio César Bai
- Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina; Research Institutes of Health, Universidad del Salvador, Buenos Aires, Argentina.
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Costa AF, Sugai E, Temprano MDLP, Niveloni SI, Vázquez H, Moreno ML, Domínguez-Flores MR, Muñoz-Suano A, Smecuol E, Stefanolo JP, González AF, Cebolla-Ramirez A, Mauriño E, Verdú EF, Bai JC. Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients. World J Gastroenterol 2019; 25:1409-1420. [PMID: 30918433 PMCID: PMC6429344 DOI: 10.3748/wjg.v25.i11.1409] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Life-long removal of gluten from the diet is currently the only way to manage celiac disease (CeD). Until now, no objective test has proven useful to objectively detect ingested gluten in clinical practice. Recently, tests that determine consumption of gluten by assessing excretion of gluten immunogenic peptides (GIP) in stool and urine have been developed. Their utility, in comparison with conventional dietary and analytical follow-up strategies, has not been fully established.
AIM To assess the performance of enzyme-linked immunosorbent assay (ELISA) and point-of-care tests (PoCTs) for GIP excretion in CeD patients on gluten-free diet (GFD).
METHODS We conducted an observational, prospective, cross-sectional study in patients following a GFD for at least two years. Using the Gastrointestinal Symptom Rating Scale questionnaire, patients were classified at enrollment as asymptomatic or symptomatic. Gluten consumption was assessed twice by 3-d dietary recall and GIP excretion (by ELISA in stool and PoCTs (commercial kits for stool and urine) in two consecutive samples. These samples and dietary reports were obtained 10 day apart one from the other. Patients were encouraged to follow their usual GFD during the study period.
RESULTS Forty-four patients were enrolled, of which 19 (43.2%) were symptomatic despite being on a GFD. Overall, 83 sets of stool and/or urine samples were collected. Eleven out of 44 patients (25.0%) had at least one positive GIP test. The occurrence of at least one positive test was 32% in asymptomatic patients compared with 15.8% in symptomatic patients. GIP was concordant with dietary reports in 65.9% of cases (Cohen´s kappa: 0.317). PoCT detected dietary indiscretions. Both ELISA and PoCT in stool were concordant (concomitantly positive or negative) in 67 out of 74 (90.5%) samples. Excretion of GIP was detected in 7 (8.4%) stool and/or urine samples from patients considered to be strictly compliant with the GFD by dietary reports.
CONCLUSION GIP detects dietary transgressions in patients on long-term GFD, irrespective of the presence of symptoms. PoCT for GIP detection constitutes a simple home-based method for self-assessment of dietary indiscretions.
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Affiliation(s)
- Ana Florencia Costa
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - Emilia Sugai
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - María de la Paz Temprano
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - Sonia Isabel Niveloni
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - Horacio Vázquez
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - María Laura Moreno
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | | | | | - Edgardo Smecuol
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - Juan Pablo Stefanolo
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - Andrea F González
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | | | - Eduardo Mauriño
- Julio César Bai: Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1263, Argentina
| | - Elena F Verdú
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S4L8, Canada
| | - Julio César Bai
- Research Institutes, Universidad del Salvador, Buenos Aires 1050, Argentina
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Zanchetta MB, Longobardi V, Costa F, Longarini G, Mazure RM, Moreno ML, Vázquez H, Silveira F, Niveloni S, Smecuol E, de la Paz Temprano M, Massari F, Sugai E, González A, Mauriño EC, Bogado C, Zanchetta JR, Bai JC. Impaired Bone Microarchitecture Improves After One Year On Gluten-Free Diet: A Prospective Longitudinal HRpQCT Study in Women With Celiac Disease. J Bone Miner Res 2017; 32:135-142. [PMID: 27447366 DOI: 10.1002/jbmr.2922] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 01/06/2023]
Abstract
We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high-resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten-free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone-specific parameters and CD serology) at both time points. Secondary, we compared 1-year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- María Belén Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Vanesa Longobardi
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Florencia Costa
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Gabriela Longarini
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Roberto Martín Mazure
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - María Laura Moreno
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Horacio Vázquez
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Fernando Silveira
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina
| | - Sonia Niveloni
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Edgardo Smecuol
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - María de la Paz Temprano
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Fabio Massari
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Emilia Sugai
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Andrea González
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Eduardo César Mauriño
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Cesar Bogado
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - José R Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Julio César Bai
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina.,Cátedra de Gastroenterología Facultad de Medicina, Universidad del Salvador, Buenos Aires, Argentina
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6
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Zanchetta MB, Costa F, Longobardi V, Longarini G, Mazure RM, Moreno ML, Vázquez H, Silveira F, Niveloni S, Smecuol E, Temprano MDLP, Hwang HJ, González A, Mauriño EC, Bogado C, Zanchetta JR, Bai JC. Significant bone microarchitecture impairment in premenopausal women with active celiac disease. Bone 2015; 76:149-57. [PMID: 25779933 DOI: 10.1016/j.bone.2015.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/23/2015] [Accepted: 03/05/2015] [Indexed: 02/07/2023]
Abstract
Patients with active celiac disease (CD) are more likely to have osteoporosis and increased risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) permits three-dimensional exploration of bone microarchitectural characteristics measuring separately cortical and trabecular compartments, and giving a more profound insight into bone disease pathophysiology and fracture. We aimed to determine the volumetric and microarchitectural characteristics of peripheral bones-distal radius and tibia-in an adult premenopausal cohort with active CD assessed at diagnosis. We prospectively enrolled 31 consecutive premenopausal women with newly diagnosed CD (median age 29 years, range: 18-49) and 22 healthy women of similar age (median age 30 years, range 21-41) and body mass index. Compared with controls, peripheral bones of CD patients were significantly lower in terms of total volumetric density mg/cm(3) (mean ± SD: 274.7 ± 51.7 vs. 324.7 ± 45.8, p 0.0006 at the radius; 264.4 ± 48.7 vs. 307 ± 40.7, p 0.002 at the tibia), trabecular density mg/cm(3) (118.6 ± 31.5 vs. 161.9 ± 33.6, p<0.0001 at the radius; 127.9 ± 28.7 vs. 157.6 ± 15.6, p < 0.0001 at the tibia); bone volume/trabecular volume ratio % (9.9 ± 2.6 vs. 13.5 ± 2.8, p<0.0001 at the radius; 10.6 ± 2.4 vs. 13.1 ± 1.3, p < 0.0001 at the tibia); number of trabeculae 1/mm (1.69 ± 0.27 vs. 1.89 ± 0.26, p 0.009 at the radius; 1.53 ± 0.32 vs. 1.80 ± 0.26, p 0.002 at the tibia); and trabecular thickness mm (0.058 ± 0.010 vs. 0.071 ± 0.008, p < 0.0001 at the radius with no significant difference at the tibia). Cortical density was significantly lower in both regions (D comp mg/cm(3) 860 ± 57.2 vs. 893.9 ± 43, p 0.02; 902.7 ± 48.7 vs. 932.6 ± 32.6, p 0.01 in radius and tibia respectively). Although cortical thickness was lower in CD patients, it failed to show any significant inter-group difference (a-8% decay with p 0.11 in both bones). Patients with symptomatic CD (n = 22) had a greater bone microarchitectural deficit than those with subclinical CD. HR-pQCT was used to successfully identify significant deterioration in the microarchitecture of trabecular and cortical compartments of peripheral bones. Impairment was characterized by lower trabecular number and thickness-which increased trabecular network heterogeneity-and lower cortical density and thickness. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture recovers and to what extend after gluten-free diet.
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Affiliation(s)
- María Belén Zanchetta
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina; Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina.
| | - Florencia Costa
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Vanesa Longobardi
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina
| | - Gabriela Longarini
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Roberto Martín Mazure
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - María Laura Moreno
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Horacio Vázquez
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Fernando Silveira
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina
| | - Sonia Niveloni
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Edgardo Smecuol
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - María de la Paz Temprano
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Hui Jer Hwang
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Andrea González
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Eduardo César Mauriño
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina
| | - Cesar Bogado
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina; Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Jose R Zanchetta
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina; Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Julio César Bai
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo", Buenos Aires, Argentina; Cátedra de Gastroenterología Facultad de Medicina, Universidad del Salvador, Buenos Aires, Argentina
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