Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac

Abstract

The only available treatment for celiac disease is life-long gluten exclusion. We conducted a cross-sectional age- and gender-matched study in 64 celiac adults on a long-term (>1 year) gluten-free diet and 74 non-celiac volunteers from Spain, using dietary, anthropometric, and biochemical parameters, as well as assessing bone mineral density and physical activity. Celiac adults had deficient intake (below 2/3 of the recommended intake) for folates, vitamin E, and iodine and low intake of calcium (below 80% of the recommended intake). Iron intake was also below 2/3 of the recommended intake in celiac women. Vitamin D intake was extremely low, and 34% of celiac patients had moderately deficient plasma levels. According to bone mineral density, celiac women may be more prone to osteopenia and osteoporosis. However, we found a perfectly analogous nutritional status scenario in celiac as compared to healthy volunteers, with the dietary deviations found being similar to those of the Spanish population, i.e., both groups followed a high-lipid, high-protein, and low-carbohydrate diet. Values for biochemical parameters were found within the reference ranges. Celiac disease had no influence on body weight, but body fat in celiac patients tended to be higher. According to our results, vitamin D, calcium, folates, vitamin E, iodine, and iron nutritional status should be specifically assessed and monitored in the celiac population.

Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet

“…Foods that are high in carbohydrates are usually also rich in fiber [ 52 ], but are unusual in the diets of celiac patients [ 17 , 19 , 44 ]. Most studies evaluating nutrient intake in GFD show low fiber intake, which is in perfect agreement with the low CHO and high fat intakes mentioned above [ 18 , 19 , 36 , 44 , 45 , 46 , 47 , 48 ]. Regarding the intake of fiber in children, no differences are found either.…”

“…All studies agree that fat intake of celiac adults is unbalanced. Some of them only show high fat intakes [ 19 , 25 , 47 ] but others also observe a high consumption of saturated fatty acids (SFA) or an excessive intake of cholesterol [ 17 , 18 , 36 , 48 ]. These results do not differ from those obtained in children, who present high fat intakes, with increased SFA/polyunsaturated (PUFA) ratio [ 4 ].…”

“…As it can be observed in Table 2 , several studies have shown that patients who follow a GFD present low carbohydrate intakes [ 18 , 19 , 25 , 45 , 47 , 48 ]. This may be due to their fear about consuming gluten that makes them reject cereals.…”

“…Some studies, like those of Martin et al [ 45 ], González et al [ 18 ] and Ballestero-Fernández et al [ 48 ], claim that the protein intake is higher than recommended in celiac patients who follow a GFD, probably due to excessive meat intake. However, other studies do not highlight the same results and neither do the ones obtained in celiac children who follow a GFD.…”

“…When analyzing vitamin intakes, there are several studies that show deficiencies for the same vitamins, such as that of vitamin D and vitamin E [ 18 , 19 , 25 , 44 , 48 ] followed by low intakes of B group vitamins like folate (B9), thiamine (B1), riboflavin (B2), and pyridoxine (B6) [ 17 , 18 , 19 , 25 , 43 , 44 , 45 , 55 ].…”