Abstract
Nutrient deficiencies are well recognized as secondary consequences of celiac disease (CD) and closely related to the clinical presentation of affected patients. Despite their clinical significance, consensus is lacking on the pattern and frequency of nutrient deficiencies in CD, the usefulness of their assessment at the time of diagnosis and during follow-up. This review aims to provide an overview of nutrient deficiencies among pediatric and adult CD patients at diagnosis and on a gluten-free diet (GFD), and their potential causes in CD. Secondly, we review their impact on CD management strategies including the potential of nutrient supplementation. A search of Medline, Pubmed and Embase until January 2019 was performed. Despite a high variability between the reported deficiencies, we noted that nutrient deficiencies occur frequently in children and adults with CD at diagnosis and during treatment with a GFD. Both inadequate dietary intake and/or diminished uptake due to intestinal dysfunction contribute to nutrient deficiencies. Most deficiencies can be restored with (long-term) treatment with a GFD and/or supplementation. However, some of them persist while others may become even more prominent during GFD. Our results indicate a lack of comprehensive evidence on the clinical efficacy of nutrient supplementation in CD management highlighting the need for further studies.
Highlights
Celiac disease (CD) is a common immune-enteropathy triggered by dietary gluten in genetically susceptible individuals [1]
To answer the main research question that forms the basis of this narrative review, we reviewed the published scientific evidence for nutrient deficiencies in pediatric and adult celiac disease (CD) patients at diagnosis and during treatment with a gluten-free diet (GFD)
Vitamin B6 intake has been reported to be below recommendations in 33% of adults, which was significantly higher compared to 17% in controls in a cross sectional case-control study by Valente et al, and in 8% of pediatric patients adhering to a GFD [111,113]
Summary
Celiac disease (CD) is a common immune-enteropathy triggered by dietary gluten in genetically susceptible individuals [1]. In CD, the immunologic response to gluten peptides causes histological abnormalities in the small intestine. These histological aberrations such as villous atrophy reduce the functional capacity of the intestine [1]. A clinically relevant consequence is malabsorption resulting in an increased risk for nutritional deficiencies. These deficiencies can contribute to clinically important comorbidities such as anemia, osteoporosis and depression [2,3,4]. Nutritional deficiencies do play a role at the time of diagnosis, and during treatment with a gluten-free diet (GFD)
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