Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study

Abstract

BackgroundNon-celiac gluten sensitivity (NCGS) or ‘wheat sensitivity’ (NCWS) is included in the spectrum of gluten-related disorders. No data are available on the prevalence of low bone mass density (BMD) in NCWS. Our study aims to evaluate the prevalence of low BMD in NCWS patients and search for correlations with other clinical characteristics.MethodsThis prospective observation study included 75 NCWS patients (63 women; median age 36 years) with irritable bowel syndrome (IBS)-like symptoms, 65 IBS and 50 celiac controls. Patients were recruited at two Internal Medicine Departments. Elimination diet and double-blind placebo controlled (DBPC) wheat challenge proved the NCWS diagnosis. All subjects underwent BMD assessment by Dual Energy X-Ray Absorptiometry (DXA), duodenal histology, HLA DQ typing, body mass index (BMI) evaluation and assessment for daily calcium intake.ResultsDBPC cow's milk proteins challenge showed that 30 of the 75 NCWS patients suffered from multiple food sensitivity. Osteopenia and osteoporosis frequency increased from IBS to NCWS and to celiac disease (CD) (P <0.0001). Thirty-five NCWS patients (46.6%) showed osteopenia or osteoporosis. Low BMD was related to low BMI and multiple food sensitivity. Values of daily dietary calcium intake in NCWS patients were significantly lower than in IBS controls.ConclusionsAn elevated frequency of bone mass loss in NCWS patients was found; this was related to low BMI and was more frequent in patients with NCWS associated with other food sensitivity. A low daily intake of dietary calcium was observed in patients with NCWS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0230-2) contains supplementary material, which is available to authorized users.

Non‐coeliac gluten or wheat sensitivity: emerging disease or misdiagnosis?

“…NCG/WS predominantly affects females (the female:male ratio is > 5:1) in their late 30s and 40s 25 . The disorder also been associated with low bone mineral density, 28 anaemia and weight loss, 27 which suggests that in some patients, malabsorption may be present. Patients are also more likely to have a family history of coeliac disease, a history of food allergy in infancy, coexistent atopic disease, 27 an increased prevalence of autoimmune disease such as Hashimoto's thyroiditis and high levels of circulating antinuclear antibodies, 29 suggesting overlap with other autoimmune and allergic diseases.…”

Non-celiac wheat sensitivity: rationality and irrationality of a gluten-free diet in individuals affected with non-celiac disease: a review

“…Because derivatives of gluten-rich grains are relevant sources of nutrients in the general diet, their exclusion from the diet could potentially have significant effects on nutritional status. For example, in patients with NCWS on a wheat-free diet, a higher frequency of osteopenia and osteoporosis than in controls has been reported [ 127 ]. In addition to the likelihood of nutritional deficiencies following a nonsupplemented and unsupervised GFD, this dietary restriction has been shown to disturb the richness and composition of gut microbiota.…”

Nutritional implications of dietary gluten avoidance among Canadians: results from the 2015 Canadian Community Health Survey

“…Our results confirm that Canadians following a GFD may be at risk for inadequate intakes of calcium and vitamin D, two nutrients integral to bone health and development. Several surveys have previously reported lower intakes of calcium and vitamin D among patients with CD (17,39) , increasing the risk of metabolic bone disease, osteoporosis, and bone fractures (40)(41)(42) . While individuals avoiding gluten are more likely to also avoid dairy compared to the general Canadian population, our results do not indicate significantly different calcium or vitamin D intake according to whether or not people also avoid dairy.…”