Abstract
Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.
Highlights
Celiac disease (CD) is the most common food intolerance in the Western population, and currently represents a major health care issue
We aimed to measure essential serum nutritional variables in order to assess the prevalence of vitamin and mineral deficiencies in untreated adult CD-patients from a tertiary referral Celiac Disease Centre, consuming a standard Dutch (Western) diet before diagnosis
The present study showed that the majority of an “early diagnosis” adult untreated CD patient group in the Netherlands, had at least one, and often several, serum vitamin or mineral deficiencies at diagnosis
Summary
Celiac disease (CD) is the most common food intolerance in the Western population, and currently represents a major health care issue. CD is an inflammatory, immune-mediated chronic disease of the mucosa of the proximal small intestine due to irreversible gluten intolerance in genetically susceptible individuals. Gluten refers to a set of amino acid sequences found in the prolamine fraction of wheat, barley and rye. The characteristic histopathological finding is a varying degree of villous atrophy and crypt hyperplasia, primarily in the duodenum and jejunum, with inflammatory changes leading to malabsorption. The first-line, and up-till- only, treatment is a lifelong strict adherence to a gluten free diet (GFD). All other treatment modalities suppress the intestinal inflammatory response and do not treat the intolerance [2,3]
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