Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease

Kreutz, Johanna M.; Adriaanse, Marlou P. M.; Ploeg, E.M.C. van der; Vreugdenhil, Anita

doi:10.3390/nu12020500

Cited by 56 publications

(61 citation statements)

References 139 publications

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“…Therefore, at diagnosis, doctors should focus not only on dietary avoidance, but also on a balanced diet. Our results are in support of a recent review [9] on nutritional deficiencies in CeD, which concludes that the early education of patients by a dietitian with expert knowledge in CeD is needed in order to address the achievement of an adequate nutrient intake. Based on our results, the dietitian consultation should also aim to increase patients' nutritional knowledge.…”

Section: Discussionsupporting

confidence: 88%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background and aim: Nutritional deficiencies are frequent in coeliac disease (CeD), mostly because of the nutritional deficits in gluten-free foods and because of wrong behaviors. We aimed to investigate the level of nutritional knowledge in a cohort of CeD patients in comparison with patients with inflammatory bowel disease (IBD) and healthy subjects. Materials and methods: We consecutively recruited CeD patients and matched-sex and -age IBD patients between April and December 2019 at the University Hospital of Padua outpatient clinic. Healthy subjects were also recruited from family and friends of the hospital staff. The CeD patients were asymptomatic on a gluten-free diet, whereas the IBD patients were in remission. All of the subjects completed the Moynihan validated questionnaire to measure their nutritional knowledge. Results: We included 96 CeD patients, 96 IBD patients, and 65 healthy controls. We found that CeD patients were less aware of nutritional recommendations compared with healthy subjects (HS), and were less able to identify nutrient sources compared with IBD patients and to choose healthy food compared with both groups. The Moynihan questionnaire mean total score was not significantly different between CeD and IBD groups (mean 22.5 ± 2.3 for CeD, 22.0 ± 2.2 for IBD), while it was statistically significantly worse in CeD compared with healthy subjects (mean 21.2 ± 2.3 for HS, p = 0.001). Conclusions: CeD patients tend to focus their diet on gluten avoidance, while IBD patients tend to follow a healthier diet, probably because they believe that diet plays a major role in regulating inflammation and, therefore, their symptoms. A dietitian consultation at CeD diagnosis is recommended.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Our data suggest that the low expression of micronutrient transporters in the intestine explains described clinical micronutrient deficiencies (ie, iron, folate, B12, and various mineral and vitamin D deficiencies) in patients following a strict GFD. 25 , 34 , 35 , 36 The low expressions might be due to inadvertent gluten ingestion and indication of disease due to early mucosal injury. Complete elimination of dietary gluten seems impossible to maintain due to issues such as contamination of gluten-free foods, resulting in the ingestion of hundreds of milligrams of gluten per day in an attempted GFD.…”

Section: Discussionmentioning

confidence: 99%

“…Complete elimination of dietary gluten seems impossible to maintain due to issues such as contamination of gluten-free foods, resulting in the ingestion of hundreds of milligrams of gluten per day in an attempted GFD. 34 , 35 , 36 , 37 Inadvertent gluten ingestion is clinically difficult to detect, as serum TG2 or endomysial antibodies do not pick up most of the patients with persistent villous atrophy on GFDs. 38 When the stool GIPs measure gluten ingestion the day or so before testing, the duodenal mucosa is reacting upon long-term and significant inadvertent gluten ingestion.…”

Section: Discussionmentioning

confidence: 99%

Genome-Wide Transcriptomic Analysis of Intestinal Mucosa in Celiac Disease Patients on a Gluten-Free Diet and Postgluten Challenge

Dotsenko

Oittinen

Taavela

et al. 2021

Cellular and Molecular Gastroenterology and Hepatology

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Background & Aims Gluten challenge studies are instrumental in understanding the pathophysiology of celiac disease. Our aims in this study were to reveal early gluten-induced transcriptomic changes in duodenal biopsies and to find tools for clinics. Methods Duodenal biopsies were collected from 15 celiac disease patients on a strict long-term gluten-free diet (GFD) prior to and post a gluten challenge (PGC) and from 6 healthy control individuals (DC). Biopsy RNA was subjected to genome-wide 3’ RNA-Seq. Sequencing data was used to determine the differences between the three groups and was compared to sequencing data from the public repositories. The biopsies underwent morphometric analyses. Results In DC vs. GFD group comparisons, 167 differentially expressed genes were identified with 117 genes downregulated and 50 genes upregulated. In PGC vs. GFD group comparisons, 417 differentially expressed genes were identified with 195 genes downregulated and 222 genes upregulated. Celiac disease patients on a GFD were not “healthy”. In particular, genes encoding proteins for transporting small molecules were expressed less. In addition to the activation of immune response genes, a gluten challenge induced hyperactive intestinal wnt-signaling and consequent immature crypt gene expression resulting in less differentiated epithelium. Biopsy gene expression in response to a gluten challenge correlated with the extent of the histological damage. Regression models using only four gene transcripts described 97.2% of the mucosal morphology and 98.0% of the inflammatory changes observed. Conclusions Our gluten challenge trial design provided an opportunity to study the transition from health to disease. The results show that even on a strict GFD, despite being deemed healthy, patients reveal patterns of ongoing disease. Here, a transcriptomic regression model estimating the extent of gluten-induced duodenal mucosal injury is presented.

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“…For example, iron, folate, and B12 along with mineral and vitamin D deficiencies are frequent. 27,42 Gluten-free products may not be of optimal nutritional quality 43 , and lack of fortification may increase the risk of the deficiencies in celiac sufferers. 44 Kreutz et al speculated that, in addition to inadequate dietary intake, diminished uptake due to intestinal dysfunction would contribute to these nutrient deficiencies in celiac disease patients on a GFD.…”

Section: Discussionmentioning

confidence: 99%

Genome-wide transcriptomic analysis of intestinal mucosa in celiac disease patients on a gluten-free diet and post gluten challenge

Dotsenko

Oittinen

Taavela

et al. 2020

Preprint

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Background & AimsGluten challenge studies are instrumental in understanding the pathophysiology of celiac disease. Our aims in this study were to reveal early gluten-induced transcriptomic changes in duodenal biopsies and to find tools for clinics.MethodsDuodenal biopsies were collected from 15 celiac disease patients on a strict long-term gluten-free diet (GFD) prior to and post a gluten challenge (PGC) and from 6 healthy control individuals (DC). Biopsy RNA was subjected to genome-wide 3’ RNA-Seq. Sequencing data was used to determine the differences between the three groups and was compared to sequencing data from the public repositories. The biopsies underwent morphometric analyses.ResultsIn DC vs. GFD group comparisons, 167 differentially expressed genes were identified with 117 genes downregulated and 50 genes upregulated. In PGC vs. GFD group comparisons, 417 differentially expressed genes were identified with 195 genes downregulated and 222 genes upregulated. Celiac disease patients on a GFD were not “healthy”. In particular, genes encoding proteins for transporting small molecules were expressed less. In addition to the activation of immune response genes, a gluten challenge induced hyperactive intestinal wnt-signaling and consequent immature crypt gene expression resulting in less differentiated epithelium. Biopsy gene expression in response to a gluten challenge correlated with the extent of the histological damage. Regression models using only four gene transcripts described 97.2% of the mucosal morphology and 98.0% of the inflammatory changes observed.ConclusionsOur gluten challenge trial design provided an opportunity to study the transition from health to disease. The results show that even on a strict GFD, despite being deemed healthy, patients reveal patterns of ongoing disease. Here, a transcriptomic regression model estimating the extent of gluten-induced duodenal mucosal injury is presented.

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Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease

Cited by 56 publications

References 139 publications

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

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

Genome-Wide Transcriptomic Analysis of Intestinal Mucosa in Celiac Disease Patients on a Gluten-Free Diet and Postgluten Challenge

Genome-wide transcriptomic analysis of intestinal mucosa in celiac disease patients on a gluten-free diet and post gluten challenge

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