Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet

Abstract

Background: Celiac disease responds to dietary gluten withdrawal, but data on the long-term effects of gluten-free diets are discordant. Objective: Our aim was to evaluate the nutritional status and body composition of adult celiac disease patients consuming a gluten-free diet who were in clinical, biochemical, and histologic remission. Design: We studied 71 patients (51 women and 20 men; mean age: 27 y; range: 17-58 y) and 142 healthy control subjects matched by sex and age. The subjects' height, weight, body mass index, fat and lean mass, and bone mineral content (evaluated by dual-energy X-ray absorptiometry) were measured; a 3-d dietary questionnaire was administered; and total daily energy, fat, carbohydrate, and protein intakes were calculated. Results: The weight, height, and body mass index of male celiac disease patients and the weight and body mass index of female celiac disease patients were significantly lower than the corresponding measurements in control subjects. The fat and lean mass of both male and female patients was significantly different from that of control subjects; however, bone mineral content was significantly lower only in females in whom celiac disease was diagnosed in adulthood. Total energy intake was lower in the patients than in the control subjects (9686 ± 1569 and 11 297 ± 1318 kJ/d in males and 6736 ± 1318 and 7740 ± 1715 kJ/d in females), and the diet of the patients was unbalanced, with a higher percentage of energy as fat and a lower percentage of energy as carbohydrates. Conclusions: Although strictly compliant with their gluten-free diet and in complete remission, patients with celiac disease showed differences in body composition and dietary intakes compared with control subjects. Strict follow-up and dietary advice in terms of the choice and composition of foods seem necessary to prevent malnutrition.Am J Clin Nutr 2000;72:937-9.

A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population

“…Of greater concern is that over one-third of patients are exceeding the recommended percentage of energy from fat. In contrast to findings in previous studies (Kemppainen et al, 1995;Bardella et al, 2000;Capristo et al, 2000) our results showed that patients with CD are actually having a lower average intake of fat than the general population, and get a smaller proportion of total energy from fat. Only one study has found similar findings and this was only in females (Bjorkman et al, 1985).…”

“…Bjorkman et al (1985) and Bardella et al (2000) found that the GFD resulted in a significant decrease in mean energy intake and significantly lower total daily intake of energy than controls, whereas Kemppainen et al (1995) found intakes of energy were significantly greater in patients with CD compared to the controls (Po0.05). Collins et al (1986) found that 24% patients had a lower energy than the estimated average requirements (EARs).…”

“…Often the continued ingestion of small amounts of gluten is held responsible for this. However, lower body weight and body mass index, and poor vitamin status could not be attributed to malabsorption as normal intestinal permeability has been found (Bardella et al, 2000;Hallert et al, 2002). Therefore, it is possible that it is the GFD itself that could be causing these deficiencies by not providing adequate nutrition.…”

“…Little research has been carried out on the nutritional adequacy of the GFD in terms of macronutrients, and authors have arrived at conflicting results (Table 1) (Bjorkman et al, 1985;Collins et al, 1986;Kemppainen et al, 1995;McFarlane et al, 1995;Bardella et al, 2000;Capristo et al, 2000;Grehn et al, 2001). Bjorkman et al (1985) and Bardella et al (2000) found that the GFD resulted in a significant decrease in mean energy intake and significantly lower total daily intake of energy than controls, whereas Kemppainen et al (1995) found intakes of energy were significantly greater in patients with CD compared to the controls (Po0.05).…”

The development of a composition database of gluten-free products

“…However, little information is available on the nutritional composition of these GF products. Composition data useful to evaluate the adequacy of nutrient intake of coeliac patients, on which the debate is still open (6)(7)(8)(9) , are therefore strongly needed. In the present work, we built a database of composition of a number of foods representing the main sources of intake of GF products in the Italian diet.…”