Vitamin and mineral deficiency in children newly diagnosed with celiac disease

Abstract

IntroductionCeliac disease is a chronic autoimmune disease that particularly affects the proximal small bowel (1). An autoimmune-mediated mechanism plays a part in the pathophysiology of the disease, and small bowel mucosal injury and malabsorption occur due to the hypersensitivity to gluten in prone individuals. Vitamin and mineral deficiency may also be seen depending upon malabsorption. Consequently, the clinical symptoms of the disease are not limited to the gastrointestinal system and may appear with a heterogeneous clinical spectrum involving the extraintestinal system. The typical symptoms of the disease include chronic diarrhea, abdominal distention, and growth retardation (2,3). However, the disease may also manifest itself with extraintestinal findings related to the hematologic, endocrine, and autoimmune systems. Anemia is the most frequently seen disorder in the hematologic system that often develops due to iron deficiency (4-9). Hypocalcemia and osteopenia may also occur due to vitamin D deficiency (10,11). No extensive study has been conducted regarding the vitamin and mineral deficiencies of pediatric patients diagnosed with celiac disease up to the present. Accordingly, it is the objective of this study to determine the frequency of vitamin A, D, and E deficiency, as well as zinc and mineral deficiencies, in pediatric patients diagnosed with celiac disease at the time of application to our clinic. Materials and methodsThe files of the patients diagnosed with celiac disease and followed in our Pediatric Gastroenterology, Hepatology, and Nutrition Clinic from June 2008 to June 2013 were reviewed retrospectively. Patients with complete file records and vitamin and mineral levels checked at the time of application were enrolled in the study. The demographic characteristics, complaints at the time of application, findings of duodenal biopsy, and serum 25 OH vitamin D, vitamin A, vitamin E, iron, and zinc levels of the patients were taken from the file records. The study was approved by the Ethics Committee of İnönü University (approval number 162/2013).The diagnosis of celiac disease was established in accordance with the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition's guidelines Background/aim: To establish the frequency of vitamin and mineral deficiency in children newly diagnosed with celiac disease. Materials and methods:The files of patients diagnosed with celiac disease in our Pediatric Gastroenterology Clinic from June 2008 to June 2013 were reviewed retrospectively.Results: A total of 52 pediatric patients diagnosed with celiac disease via serology and duodenal biopsy and who fulfilled the study criteria were enrolled in the study. The mean diagnosis age of the patients was 8.5 ± 3.9 years and 33 (63.5%) of the patients were female. Vitamin D, vitamin A, vitamin E, zinc, and iron deficiencies were determined in 27 (51.9%), 4 (7.7%), 7 (13.5%), 35 (67.3%), and 18 (34.6%) patients, respectively, at the time of diagnosis. Vitamin D deficiency was observed more frequent...

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“…It can be different in the case of diseases, like CD. Vitamin A deficiency is not commonly observed in CD and was estimated at 7–8% [22,23]. In our study, vitamin A deficiency (defined as vitamin A plasma concentration below 0.45 µmol/L; reference Mayo Clinical Laboratories) was not observed, and the concentration of this vitamin was not influenced by prebiotic administration.…”

“…An inverse correlation between vitamin D levels and the development of autoimmune, neurodegenerative, or cardiovascular diseases has also been reported [1,20]. The worldwide prevalence of vitamin D deficiency is estimated at 15% of the population [21], while this prevalence is higher in CD patients at diagnosis, ranging from 40 to 97% depending on the study [22,23]. Since vitamin D levels have been found to be negatively correlated with age [18], vitamin D deficiency is even more common in adult CD patients.…”

“…A gluten-free diet improves vitamin D status only in a subset of CD patients. In recently published data, vitamin D deficiency was reported in 52% of children with newly diagnosed CD [22]. In a study by Mager et al [24], a suboptimal level of 25(OH)D was noted in 43% of children and adolescents with CD at diagnosis, and a GFD diet decreased this prevalence by half.…”

“…Fat-soluble vitamins A and E are accumulated in the body; therefore, their deficiency is not commonly observed in healthy individuals [22]. It can be different in the case of diseases, like CD.…”

“…In our study, vitamin A deficiency (defined as vitamin A plasma concentration below 0.45 µmol/L; reference Mayo Clinical Laboratories) was not observed, and the concentration of this vitamin was not influenced by prebiotic administration. Vitamin E deficiency is more commonly observed, affecting 13.5% of CD children [22]. Vitamin E comprises tocopherols and tocotrienols with α-tocopherol being the most important antioxidant [27].…”