Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet

Abstract

Few celiac patients are underweight at diagnosis and a large minority is overweight; these are less likely to present with classical features of diarrhea and reduced hemoglobin. Failed or delayed diagnosis of celiac disease may reflect lack of awareness of this large subgroup. The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.

Celiac disease and obesity: need for nutritional follow-up after diagnosis

“…GFD seems to increase the risk of overweight or obesity, and concerns have been raised about the nutritional imbalance and hypercaloric content of commercial or natural gluten-free food. There is a trend, both in adults and in children, on a GFD to replace gluten-derived carbohydrates with an increased consumption of fats, proteins and hypercaloric beverages and to decrease fiber intake (Mariani et al, 1998;Dickey and Kearney, 2006;Ferrara et al, 2009). Incorrect dietary habits can be induced by unpalatability and expense of commercial gluten-free products or by the availability of commercial gluten-free snacks and biscuits with a high content of lipids.…”

“…Some reports in the literature also suggest that CD and obesity can coexist in both childhood and adolescence (Conti-Nibali et al, 1987;Franzese et al, 2001;Oso and Fraser, 2006;Arslan et al, 2009). Furthermore, patients with CD who have normal nutritional status, or are overweight at presentation, would be at further risk of obesity after gluten-free diet (GFD) because of improved intestinal absorption and unbalanced diet rich in lipids and proteins (Mariani et al, 1998;Dickey and Kearney, 2006).…”

Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control

“…While, in patients with celiac disease alone, concern has been raised about gaining weight when on a GFD [22] , recent data show normal growth patterns in children and adolescents with type 1 diabetes and celiac disease [23] , with body mass index and height standard deviation scores only marginally but not significantly higher in the control (non-celiac) than the study group, and similar to subjects with celiac disease with good or fair/poor adherence to a GFD throughout the follow-up period. Among the reasons for increased BMI, the macronutrient composition of gluten-free foods, a high percentage of saturated fat and carbohydrates with high glycemic index, and a low percentage of proteins and fiber can be included.…”

“…However, data on weight gain (and BMI increasing) in patients with celiac disease are inconsistent. Dickey et al [22] showed that nearly 80% of patients gained some weight after 2 years on GFD, and about 51% were even overweight or obese. On the contrary, a recent study reported a weight loss in obese or overweight patients while on GFD [25] , with a similar improvement in screen-and symptom-detected celiac disease patients on a GFD.…”

Age-related differences in celiac disease: Specific characteristics of adult presentation

“…Even though malnutrition is a frequent manifestation in CD, mainly in adults, excessive weight or obesity may also be present at diagnosis. Recent studies have shown that more than half the adults diagnosed with CD have obesity while only 15% of them are below their normal weight [16,17] . These figures are from European and North American studies, where the prevalence of obesity among the adult population is high.…”