Influence of Mediterranean Diet Adherence and Physical Activity on Bone Health in Celiac Children on a Gluten-Free Diet

Abstract

We aimed to assess the influence of the Mediterranean Diet adherence and physical activity (PA) on body composition, with a particular focus on bone health, in young patients with celiac disease (CD). The CD group (n = 59) included children with CD with a long (>18 months, n = 41) or recent (<18 months, n = 18) adherence to a gluten-free diet (GFD). The non-celiac group (n = 40) included non-celiac children. After adjusting for potential confounders, the CD group showed lower body weight (p = 0.034), lean mass (p = 0.003), bone mineral content (p = 0.006), and bone Z-score (p = 0.036) than non-celiac children, even when the model was further adjusted for adherence to a GFD for at least 18 months. Among CD children, spending greater time in vigorous physical activity was associated with higher lean mass (p = 0.020) and bone mineral density with evidence of statistical significance (p = 0.078) regardless of the time they followed a GFD. In addition, a greater Mediterranean Diet adherence was associated with a higher bone Z-score (p = 0.020). Moreover, lean mass was strongly associated with bone mineral density and independently explained 12% of its variability (p < 0.001). These findings suggest the importance of correctly monitoring lifestyle in children with CD regarding dietary habits and PA levels to improve lean mass and, consequently, bone quality in this population.

Study of effect of gluten-free diet on vitamin D levels and bone mineral density in celiac disease patients

“…Cause of metabolic disease in celiac is multifactorial, persistent activation of inflammation along with calcium and vitamin D malabsorption is also important cause of metabolic bone disease in these patients. [ 5 6 ]…”

It Is High Time for Personalized Dietary Counseling in Celiac Disease: A Systematic Review and Meta-Analysis on Body Composition

“…Sixteen studies compared CD patients on a GFD to a non-celiac control group [ 9 , 10 , 11 , 13 , 14 , 15 , 16 , 26 , 27 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], only four of which could be included in the meta-analysis [ 11 , 13 , 26 , 37 ]. In terms of the main outcomes, only FM and FFM were reported in similar units.…”

“…Sixteen studies assessed CD patients after at least a one-year GFD and non-celiac control subjects [ 9 , 10 , 11 , 13 , 14 , 15 , 16 , 26 , 27 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Eight used DXA [ 11 , 13 , 26 , 27 , 37 , 38 , 39 , 42 ], five used BIA [ 9 , 15 , 38 , 40 , 43 ], three used STM [ 14 , 16 , 41 ] and one used ID as a method for body composition analysis [ 10 ]. Ten studies included adults [ 10 , 11 , 13 , 14 , 15 , 26 , 37 , 39 , 40 , 41 ]; another seven included children [ 9 , 16 , 27 , 37 , 38 , 42 , 43 ].…”

“…Eight used DXA [ 11 , 13 , 26 , 27 , 37 , 38 , 39 , 42 ], five used BIA [ 9 , 15 , 38 , 40 , 43 ], three used STM [ 14 , 16 , 41 ] and one used ID as a method for body composition analysis [ 10 ]. Ten studies included adults [ 10 , 11 , 13 , 14 , 15 , 26 , 37 , 39 , 40 , 41 ]; another seven included children [ 9 , 16 , 27 , 37 , 38 , 42 , 43 ]. One study used both DXA and BIA to assess body composition [ 38 ] and another one included both adults and children [ 37 ].…”

“…One study used both DXA and BIA to assess body composition [ 38 ] and another one included both adults and children [ 37 ]. CD patients had significantly lower FM in five studies [ 10 , 11 , 13 , 14 , 15 ] and FFM in six studies [ 10 , 11 , 15 , 37 , 38 , 42 ] and significantly higher FFM in one study [ 14 ], compared to the control group. In one case, FFM among CD patients was significantly higher than that of controls [ 14 ].…”