Metabolic Alterations in Celiac Disease Occurring after Following a Gluten-Free Diet

Abstract

<b><i>Background and Aim:</i></b> Many investigations have demonstrated that changes in body weight are frequent in patients with coeliac disease (CD) after a gluten-free diet (GFD); conversely data on the metabolic syndrome (MS) and hepatic steatosis (HS) are still rare. The aim is to evaluate the prevalence of MS and HS in patients with CD, before and after a GFD. <b><i>Methods:</i></b> One hundred eighty-five coeliac adult patients were enrolled in the study. Diagnosis of MS was made according to the current international criteria including waist circumference (WC), hypertension, reduction of high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, and hyperglycemia. Body mass index (BMI), hypercholesterolemia, and HS were also assessed. <b><i>Results:</i></b> CD patients showed an increased risk of developing both MS and HS after following a GFD. MS was reported in 3.24% of the cases at the time of CD diagnosis and in 14.59% after GFD (<i>p</i> < 0.0001). HS was reported in 1.7% at the time of diagnosis and in 11.1% after GFD (<i>p</i> < 0.0001). With regard to metabolic sub-categories, the prevalence of the increase in WC, hypertension, reduction of HDL cholesterol, hyperglycemia, hypercholesterolemia, and BMI > 25 was significantly higher after GFD compared to baseline at CD diagnosis. <b><i>Conclusion:</i></b> In CD patients, following a GFD maybe can contribute to the development of MS and HS. Patients should be informed about this possible risk.

A Survey on Nutritional Knowledge in Coeliac Disease Compared to Inflammatory Bowel Diseases Patients and Healthy Subjects

“…A study in children showed that the intakes of simple sugars, fats, and protein exceeded the national recommendations for health [20]. The dietary imbalance could contribute to the higher prevalence of the increase in waist circumference, hypertension, reduction of HDL cholesterol, hyperglycaemia, hypercholesterolemia, BMI > 25, and hepatic steatosis after GFD compared with baseline at CeD diagnosis, recently reported [11].…”

“…According to the CeD guidelines [1,8], patients should be referred to a dietitian to discuss dietary management, so as to avoid gluten contamination and nutritional deficiencies. Gluten-free diet (GFD) has been in fact associated with possible diet imbalances [9], which could contribute to the higher risk of metabolic syndrome and hepatic steatosis [10,11] described in recent literature in CeD patients at follow-up. Dietary imbalance on a GFD might be related to the general nutritional knowledge of CeD patients, which, based on our knowledge, has never been investigated.…”

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders

“…In a retrospective study with a longer follow-up period (2 years) that included patients on a GFD with a new diagnosis of CD, 81% gained weight, including 82% of initially overweight patients [4]. In another retrospective study, the number of patients with a BMI > 25 kg/m 2 increased significantly after the initiation of a GFD (45/185 vs. 78/185; p = 0.0001; follow-up of 7 years; range 1-36 years) [35].…”

“…Nine studies assessed the BMI changes in CD patients before and after starting a GFD [4,11,[29][30][31][32][33][34][35]. Six of these studies analyzed BMI changes as expressed by the mean or median (Table 1)…”

“…Nine studies assessed the BMI changes in CD patients before and after starting a GFD [4,11,[29][30][31][32][33][34][35]. Six of these studies analyzed BMI changes as expressed by the mean or median (Table 1) [11,[29][30][31][32][33], while the remaining three studies evaluated the number of patients with changes in their BMIs in terms of a percentage [4,34,35].…”