Serum Vitamins and Minerals at Diagnosis and Follow‐up in Children With Celiac Disease

Deora, Vini; Aylward, Nicole; Sokoro, AbdulRazaq; El‐Matary, Wael

doi:10.1097/mpg.0000000000001475

Cited by 65 publications

(66 citation statements)

References 22 publications

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“…In humans, deficient/insufficient 25(OH)D concentrations have also been linked to multiple autoimmune conditions, including multiple sclerosis, rheumatoid arthritis, Crohn’s disease, celiac disease, systemic lupus erythematosus, and asthma . In diabetes‐prone non‐obese diabetic (NOD) mice, lifelong vitamin D supplementation significantly reduced diabetes development in both male and female mice .…”

Section: Introductionmentioning

confidence: 99%

Vitamin D status, enterovirus infection, and type 1 diabetes in Italian children/adolescents

et al. 2018

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At the time of the clinical onset of type 1 diabetes (T1D), we investigated 82 pediatric cases in parallel with 117 non-diabetic controls matched by age, geographic area, and time of collection. The occurrence of an enteroviral infection was evaluated in peripheral blood using a sensitive method capable of detecting virtually all human enterovirus (EV) types. While non-diabetic controls were consistently EV-negative, 65% of T1D cases carried EVs in blood. The vitamin D status was assessed by measuring the concentration of 25-hydroxyvitamin D [25(OH)D] in serum. Levels of 25(OH)D were interpreted as deficiency (≤50 nmol/L), insufficiency (52.5-72.5 nmol/L), and sufficiency (75-250 nmol/L). In T1D cases, the median serum concentration of 25(OH)D was 54.4 ± 27.3 nmol/L vs 74.1 ± 28.5 nmol/L in controls (P = .0001). Diabetic children/adolescents showed deficient levels of vitamin D 25(OH)D (ie, 72.5 nmol/L) in 48.8% cases vs 17.9% in non-diabetic controls (P = .0001). Unexpectedly, the median vitamin D concentration was significantly reduced in virus-positive vs virus-negative diabetics (48.2 ± 22.5 vs 61.8 ± 31.2 nmol/L; P = .015), with deficient levels in 58.5% vs 31.0%, respectively. Thus, at the time of clinical onset, EV-positive cases had reduced vitamin D levels compared with EV-negative cases. This could indicate either that the virus-negative children/adolescents had been hit by a non-infectious T1D-triggering event, or that children/adolescents with proper levels of vitamin D had been able to rapidly clear the virus. Thus, it would be important to assess whether adequate vitamin D supplementation before or during the prediabetic phase of T1D may counteract the diabetogenic potential of infectious pathogens.

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Section: Introductionmentioning

confidence: 99%

Vitamin D status, enterovirus infection, and type 1 diabetes in Italian children/adolescents

et al. 2018

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“…Impaired mucosal absorption of various micronutrients is welldescribed in the setting of active CD [20,21] . Although the lack of complete assessment limited interpretation, a number of children in the current cohort were found to have micronutrient deficiencies.…”

Section: Discussionmentioning

confidence: 99%

Presentation Patterns and Nutritional Impact of Coeliac Disease in New Zealand Children

Adamji

Whitehead

Day

2017

Journal of Gastroenterology and Hepatology Research

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RESULTS:Over the study period, 110 children were diagnosed at mean age of 7.37 years. The most common presenting symptom was abdominal pain. Sixteen children were diagnosed following screening in high risk groups, with 14 being asymptomatic. Eighteen children were iron deficient and twelve vitamin D deficient. CONCLUSIONS: CD was diagnosed in children of all ages, with various presentation patterns. Micronutrient deficiencies were commonly seen at diagnosis. Ongoing assessment of patterns of CD in NZ children is required. INTRODUCTIONCoeliac disease (CD) is an autoimmune disease of the small bowel, triggered by dietary exposure to gluten in genetically susceptible individuals [1] . Ingestion of gluten provokes immune-mediated damage to the small intestinal mucosa. The optimal management of CD currently involves institution of a life-long gluten free diet (GFD) [2] . The features of CD can develop at any age whilst on a gluten containing diet [3] . CD can have variable presentations from gastrointestinal symptoms to non-specific symptoms such as headaches or lethargy [4][5][6] . In addition, many individuals are increasingly identified consequent to active screening in groups at higher risk of CD (such as those with positive family history or type 1 diabetes) and a number of these individuals may be asymptomatic at diagnosis [7] . CD appears to be increasing in prevalence in many countries around the world, including New Zealand [7] . A population-based study conducted in the Christchurch region of New Zealand in the last years of the 20 th century using electoral roll records, showed a prevalence of 1.2% [8] . A further study in the same region documented more individuals being diagnosed with CD each year [9] . Subsequently AIM:To evaluate the presentation patterns of a cohort of children diagnosed with coeliac disease at Christchurch Hospital, New Zealand. METHODS: Children aged 15 years or less diagnosed with CD (based upon standard histological criteria) over a five year period were identified retrospectively. Presenting symptoms, anthropometry, serology and micronutrients were reviewed.

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“…The nutritional deficiencies described among coeliac disease patients included iron, vitamin B12, folic acid, fat‐soluble vitamins and others . However, such descriptions were mainly reserved to adults, while reports on nutritional deficiencies, especially those of fat‐soluble vitamins, in children at the time of diagnosis were inconclusive . Therefore, it is uncertain whether the recommendation for routine assessment of fat‐soluble vitamins for adults also applies to children.…”

Section: Introductionmentioning

confidence: 99%

Vitamin A levels are comparable between children with newly diagnosed coeliac disease and non‐coeliac controls

et al. 2019

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Aim: Nutritional deficiencies associated with coeliac disease include iron, folic acid and fat-soluble vitamins. This study compared the prevalence and degree of vitamin A deficiency among newly diagnosed coeliac disease patients to controls in a developed country. Methods: This prospective cohort study included all children evaluated by gastroscopy atDana-Dwek Children's Hospital, Israel, between September 2014 and February 2017. Vitamin A, haemoglobin, C-reactive protein (CRP), ferritin, tissue transglutaminase, immunoglobulin A and vitamin D levels were measured.Results: Of the 113 children (69% females), 47 were diagnosed with coeliac disease whereas the others were the controls (mean age of 8.2 AE 3.8 years and 12.4 AE 3.5 years, respectively). There was no group difference in vitamin A, vitamin D or CRP levels. Among coeliac children, two had true vitamin A deficiency compared with three controls, while 18 coeliac children had subclinical vitamin A deficiency compared with 25 controls (p > 0.05).Conclusion: Paediatric coeliac disease was not associated with increased prevalence of vitamin A deficiency. Children evaluated for gastrointestinal complaints in a developed country were found to have an unexpectedly high prevalence of subclinical vitamin A deficiency. Further prevalence and causality assessments of vitamin A deficiency in developed countries are needed.

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Serum Vitamins and Minerals at Diagnosis and Follow‐up in Children With Celiac Disease

Abstract: At diagnosis, most children with CD have vitamin D deficiency. The degree of micronutrient deficiencies does not correlate with the degree of villous atrophy or serum titers of anti-TtG IgA antibodies.

Cited by 65 publications

References 22 publications

Vitamin D status, enterovirus infection, and type 1 diabetes in Italian children/adolescents

Vitamin D status, enterovirus infection, and type 1 diabetes in Italian children/adolescents

Presentation Patterns and Nutritional Impact of Coeliac Disease in New Zealand Children

Vitamin A levels are comparable between children with newly diagnosed coeliac disease and non‐coeliac controls

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