Gluten-Free Diet Impact on Leptin Levels in Asymptomatic Coeliac Adolescents: One Year of Follow-Up

Abstract

Coeliac disease, daily more frequently diagnosed in our population, involves many organs also in oligosymptomatic patients and with an adequate nutritional regime. Possible endocrine implications include failure to thrive, pubertal delay and reproduction diseases due to deregulation of GH, FSH and LH secretion. Leptin, an adipose tissue hormone, can be decreased as well and its deficiency could be related to growth and puberty anomalies. We studied 14 asymptomatic coeliac patients in peripubertal age (7.5–13.8 years) and tested their leptin levels in order to correlate them with endocrine and anthropometric data. Before the diet was started leptinaemia (M±DS) was: 4.94 ± 5.53 ng/ml. In 10/14 patients (71%) leptinaemia was ≤2 DS for gender and age. In all the patients, after a period of 6–12 months of gluten-free diet, Leptin levels appreciably raised to 10.8 ± 7.9 ng/ml, with a significant correlation to the time of the diet. Leptinaemia was actually lower in patients with a severe mucosal atrophy, and in these patients it increased more significantly after the diet was started. The removal of gluten itself may reduce immunological hit to adipose tissue and the ‘malnutrition’ of adipocytes: leptin can hence increase despite no significant increase of body mass index occurs. This study could partially explain the correlation between body mass index, Coeliac disease and the deregulation of puberty and fertility, mainly in patients who started the diet late. It could also explain the reversibility of this alteration if the cause is removed.

Incretins, amylin and other gut‐brain axis hormones in children with coeliac disease

“…Blanco Quiros A et al agree with the observation about sex dependence of leptin levels in patients with CD, although they have reported reduced leptin levels in active coeliac disease in agreement with later studies too, possibly reflecting again poor nutritional status and reduced adipose tissue of untreated patients with CD [52,53]. The impact of GFD on leptin levels in asymptomatic coeliac disease adolescents showed that leptinemia was lower in patients with a severe mucosal atrophy, and in those patients, leptin was markedly increased after the diet was initiated [54]. It seems that leptin concentrations may be affected not only by GFD diet but also by the time of the GFD initiation.…”

“…However, one limitation of our study is the high prevalence of female subjects in the group of DCD; therefore, definite conclusions regarding the sexual dimorphism cannot be drawn from our study. The impact of GFD on leptin levels in asymptomatic coeliac disease adolescents showed that leptinemia was lower in patients with a severe mucosal atrophy, and in those patients, leptin was markedly increased after the diet was initiated [54]. As expected, only leptin levels in control group differ significantly between girls and boys (P < 0Á001), while no differences were found for other studied hormones levels.…”

Serum Concentrations of Insulin, Ghrelin, Adiponectin, Leptin, Leptin Receptor and Lipocalin-2 in Children with Celiac Disease Who Do and Do Not Adhere to a Gluten-Free Diet

“… 39 Similar results were reported for the CD children and adults although in these patients there was no increase of the leptin level after a GFD despite significant increase in fat mass. 40 In IBD patients, serum leptin levels were found to be decreased (with or without statistical significance) and did not correlate with the indices of disease activity. However, some authors have found increased levels of the serum leptin that positively correlated with IBD.…”

Bone Mineralization in Celiac Disease

“…Indeed, it is involved in a regulatory loop that appears to explain the protective effect of obesity on bone mass in humans. Leptinaemia levels were found to be low and to significantly increase after GFD in patients with severe intestinal atrophy [44]. …”