Metabolic and Nutritional Features in Adult Celiac Patients

Abstract

Celiac disease (CD) is a chronic immune-mediated gluten-dependent enteropathy induced by ingestion of gluten-containing products, characterized by intestinal malabsorption and subtotal or total atrophy of intestinal villi, which improves after gluten-free diet (GFD). Untreated patients affected by the classic form of CD are at high risk of malnutrition, but an impairment of nutritional status is frequently reported also in patients with the subclinical form of the disease. Strict adherence to a GFD greatly improves nutritional status, inducing an increase in fat and bone compartments, but does not completely normalize body composition. A lack of improvement in nutritional status may identify incomplete adherence to GFD treatment. Evidence has shown lower body weights and lower fat mass and fat-free mass contents in CD patients. Untreated CD patients oxidize more carbohydrates as energy substrate compared to treated subjects. In addition, circulating ghrelin concentration was reduced after GFD treatment as a possible consequence of body composition improvement, while leptin did not correlate with the changes in body composition and substrate oxidation in patients with CD. A significant correlation was reported between ghrelin and the degree of severity of intestinal mucosal lesions. CD patients might show an alteration in lipid metabolism, i.e. low serum total and high- density lipoprotein-cholesterol as a consequence of lipid malabsorption and decreased intake. In conclusion, weight loss and nutritional deficiencies are relevant clinical features in CD. Thus, an early and accurate evaluation of nutritional status and energy metabolism represents a fundamental tool in the management of CD patients.

Refractory celiac disease and EATL patients show severe malnutrition and malabsorption at diagnosis

“…Lower body weights, BMI, FM and FFM have been reported [29]. Untreated CD patients have a BMI that is approximately 2.3 points lower than that in controls, but this is usually reversible on a GFD.…”

Wheat Belly—An Analysis of Selected Statements and Basic Theses from the Book

“…Analysis -Numerous studies have shown that adults and children with celiac disease who stick to a gluten-free diet have higher BMIs than those who do not (43)(44)(45)(46). This is due in part to the highly available starch in diets based on tapioca, potato, and corn starches.…”

Increased Serum High-density Lipoprotein-Cholesterol Concentration in Celiac Disease After Gluten-free Diet Treatment Correlates With Body Fat Stores

“…1,2 An increasing prevalence of the subclinical and silent forms of CD, characterized by few or even absence of symptoms was reported, 3,4 thus the identification of risk groups could represent a key factor for an early diagnosis of CD with consequent decreased risk of developing malignant and nonmalignant complications. [1][2][3] In addition, patients with CD often show an impairment of nutritional status, either those with the classic or the subclinical form of the disease [4][5][6] and strict adherence to GFD was found to improve but not to completely normalize the body composition in these patients. 5,6 A great prevalence of CD was recently reported among patients with low high-density lipoprotein-cholesterol (HDL-C) concentration, 7 probably as a consequence of decreased lipid absorption, reduction in cholesteroltransporting lipoproteins, and decreased apolipoprotein (Apo)-AI secretion from the altered small bowel mucosa.…”

“…[1][2][3] In addition, patients with CD often show an impairment of nutritional status, either those with the classic or the subclinical form of the disease [4][5][6] and strict adherence to GFD was found to improve but not to completely normalize the body composition in these patients. 5,6 A great prevalence of CD was recently reported among patients with low high-density lipoprotein-cholesterol (HDL-C) concentration, 7 probably as a consequence of decreased lipid absorption, reduction in cholesteroltransporting lipoproteins, and decreased apolipoprotein (Apo)-AI secretion from the altered small bowel mucosa. [7][8][9][10][11][12] In fact, as Apo-AI represents up to 70% of HDL-C particles, a defect in its secretion may determine a reduction in HDL-C in the bloodstream.…”