Nutritional Status in Spanish Children and Adolescents with Celiac Disease on a Gluten Free Diet Compared to Non-Celiac Disease Controls

Abstract

Patients who follow a gluten-free diet (GFD) may be prone to nutritional deficiencies, due to food restriction and consumption of gluten-free products. The aim was to assess nutritional status in celiac children and adolescents on a long-term GFD. A cross-sectional age and gender-matched study in 70 celiac and 67 non-celiac volunteers was conducted, using dietary, anthropometric, biochemical parameters, and assessing bone mineral density and physical activity. Adequacy of vitamin D intake to recommendations was very low, in both groups, and intakes for calcium and magnesium were significantly lower in celiac volunteers. Celiac children and adolescents may have a higher risk of iron and folate deficiencies. Both groups followed a high-lipid, high-protein, low fiber diet. Median vitamin D plasma levels fell below reference values, in celiac and non-celiac participants, and were significantly lower in celiac girls. Other biochemical parameters were within normal ranges. Anthropometry and bone mineral density were similar within groups. With the exception of some slightly lower intakes, children and adolescents following a GFD appear to follow the same trends as healthy individuals on a normal diet. No effect of food restriction or gluten-free product consumption was observed.

Updated Food Composition Database for Cereal-Based Gluten Free Products in Spain: Is Reformulation Moving on?

“…A research group from our laboratory recently showed no relevant differences in the general nutrient quality of the diet of children and adolescents following a GFD, as compared to matched controls, in contrast to previous studies, with the exception of polyunsaturated fatty acids, folate, and calcium intakes. These were significantly lower in coeliac as compared to non-coeliac children and adolescents, as well as low when compared to the recommended intakes for these nutrients [13]. Adequacy of vitamin D intake to recommendations was dramatically low, for both coeliac and non-coeliac children and adolescents; however, only coeliac girls presented a significantly lower level of plasmatic vitamin D (below reference values, <30 ng/mL), as compared to non-coeliac controls, although without clinical repercussion in bone mass density [13].…”

“…This statement warrants the need of providing new data on mineral and vitamins in GF food products, to complete food composition tables or databases, to cover regulatory purposes, and/or to assess population dietary intakes [12]. Composition data are useful to evaluate the adequacy of nutrient intake of celiac patients, on which the debate is still open, and are, therefore, strongly needed [13].…”

“…The GFD has demonstrated benefits in managing some gluten-related disorders, although nutritional imbalances have been reported. Although a GFD is associated with being healthier by some authors [9,14], epidemiological studies indicate nutritional imbalances in different celiac populations following a GFD, both in children [13,15] and in adults [16,17]. They refer to both macronutrients and micronutrients, including minerals.…”

“…They refer to both macronutrients and micronutrients, including minerals. Overall, nutritional imbalances include high lipid, high protein, and low fiber intakes, and lack of adequacy to reference intakes of vitamin D, calcium, and magnesium [13,15]. Celiac patients may also be at risk of iron and folate deficiencies [17].…”

Is a Gluten-Free Diet Enough to Maintain Correct Micronutrients Status in Young Patients with Celiac Disease?

“…In the present study, all children covered the recommended daily intakes due to the consumption of GF vegetables and grains with a fiber content similar to wheat [35]. Data from a study conducted in Spanish children with CD also showed that fiber intake was adequate [41].…”