Zahra Setavand¹, Maryam Ekramzadeh²*, Naser Honar³ and Sara Ekramzadeh⁴

¹Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
²Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
³Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
⁴Department of Psychiatry, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

*Corresponding Author: Maryam Ekramzadeh, Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

Received: May 24, 2023; Published: June 22, 2023

Abstract

Celiac disease (CD) is an immune enteropathy with wide heterogeneous symptoms which can affect children’s growth. Since gluten-free diet (GFD) is the only treatment available for CD, the aim of the present study was to evaluate anthropometric indices and symptoms recovery in children with CD after treatment with a GFD. Seventy-four children with age of 2-18 years old and diagnosed with CD recruited from XXX specialized clinic in a quasi-experimental retrospective study. Height, weight, Body Mass Index (BMI), malnutrition based on WHO growth charts, and clinical symptoms were collected from patients’ records. A GFD was prescribed by a nutritionist and patient's nutritional needs including the amount of calories and the percentage of macronutrients were calculated. The results indicated a significant difference in height (p < 0.001), weight (p < 0.001), and height z-score (p = 0.003) before and after the intervention. No difference was seen in number of patients in different height z-scores. However, number of patients with low body weight and BMI for age had decreased at the end of study compared to the beginning. There was a remarkable reduction in clinical symptoms including diarrhea, flatulence, abdominal pain, constipation, hair loss, skin dryness and weight loss (p < 0.05). However, the number of patients with abdominal distention increased significantly. To sum up, adherence to GFD may lead to improvements in body weight and height in underweight children. Moreover, GFD have beneficial effects in reduction of CD manifestations. Further prospective trials are warranted.

Keywords: Celiac Disease; Gluten; Height; Body Weight

References

1. Fasano A and Catassi C. “Celiac disease”. New England Journal of Medicine25 (2012): 2419-2426.
2. Sollid LM. “Molecular basis of celiac disease”. Annual Review of Immunology1 (2000): 53-81.
3. Green PH and Jabri B. “Celiac disease”. Annual Review of Medicine 57 (2006): 207-221.
4. Singh P., et al. “ Global prevalence of celiac disease: systematic review and meta-analysis”. Clinical Gastroenterology and Hepatology6 (2018): 823-836. e2.
5. Hernandez L and Green PH. “Extraintestinal manifestations of celiac disease”. Current Gastroenterology Reports5 (2006): 383-389.
6. Alaedini A and Green PH. “Narrative review: celiac disease: understanding a complex autoimmune disorder”. Annals of Internal Medicine4 (2005): 289-298.
7. Lionetti E and Catassi C. “New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment”. International Reviews of Immunology4 (2011): 219-231.
8. Kuloglu Z., et al. “Celiac disease: presentation of 109 children”. Yonsei Medical Journal5 (2009): 617-623.
9. Rashid M., et al. “Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children”. Pediatrics6 (2005): e754-e759.
10. Bascunan KA., et al. “Celiac disease: understanding the gluten-free diet”. European Journal of Nutrition2 (2017): 449-459.
11. Niewinski MM. “Advances in celiac disease and gluten-free diet”. Journal of the American Dietetic Association4 (2008): 661-672.
12. Barera G., et al. “Body composition in children with celiac disease and the effects of a gluten-free diet: a prospective case-control study”. The American Journal of Clinical Nutrition 1 (2000): 71-75.v
13. , et al. “Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms”. Frontiers in Pediatrics 7 (2019): 56.
14. Sahin Y. “Celiac disease in children: A review of the literature”. World Journal of Clinical Pediatrics 4 (2021): 53-71.
15. Carbone MC., et al. “Body composition in coeliac disease adolescents on a gluten-free diet: a longitudinal study”. Acta Diabetologica1 (2003): S171-173.
16. Cheng J., et al. “Body mass index in celiac disease: beneficial effect of a gluten-free diet”. Journal of Clinical Gastroenterology 4 (2010): 267-271.
17. Dehghani SM., et al. “The effect of gluten-free diet among celiac patients aged 3-12 years old on BMI during 2006 to 2014 at Nemazee Teaching hospital”. Revista de Gastroenterología del Perú4 (2018): 323-328.
18. Kabbani TA., et al. “Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet”. Alimentary Pharmacology and Therapeutics6 (2012): 723-729.
19. Reilly NR., et al. “Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet”. Journal of Pediatric Gastroenterology and Nutrition5 (2011): 528-531.
20. Ukkola A., et al. “Changes in body mass index on a gluten-free diet in coeliac disease: a nationwide study”. European Journal of Internal Medicine4 (2012): 384-388.
21. Gilbert-Diamond D., et al. “Vitamin D deficiency and anthropometric indicators of adiposity in school-age children: a prospective study”. The American Journal of Clinical Nutrition 6 (2010): 1446-1451.
22. Yachha SK., et al. “Effect of a gluten‐free diet on growth and small‐bowel histology in children with celiac disease in India”. Journal of Gastroenterology and Hepatology8 (2007): 1300-1305.
23. Leffler DA., et al. “A prospective comparative study of five measures of gluten-free diet adherence in adults with coeliac disease”. Alimentary Pharmacology and Therapeutics9 (2007): 1227-1235.
24. Fasano A and Catassi C. “Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum”. Gastroenterology3 (2001): 636-651.
25. Polanco I. “Celiac disease”. Journal of Pediatric Gastroenterology and Nutrition 47 (2008): S3-S6.
26. Catassi C., et al. “A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease”. The American Journal of Clinical Nutrition1 (2007): 160-166.
27. Fasano A. “Clinical presentation of celiac disease in the pediatric population”. Gastroenterology 4 (2005): S68-S73.
28. Boersma B., et al. “Catch-up growth and endocrine changes in childhood celiac disease”. Hormone Research in Paediatrics1 (2002): 57-65.
29. Newnham ED., et al. “Adherence to the gluten‐free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5‐year longitudinal study from diagnosis”. Journal of Gastroenterology and Hepatology 2 (2016): 342-349.
30. Iughetti L., et al. “Growth hormone impaired secretion and antipituitary antibodies in patients with coeliac disease and poor catch-up growth after a long gluten-free diet period: a causal association?” European Journal of Pediatrics12 (2006): 897-903.
31. Eren E. “Effects of age of diagnosis and dietary compliance on growth parameters of patients with celiac disease”. Archivos Argentinos de Pediatria 4 (2018): 248-255.
32. Amin R., et al. “A longitudinal study of the effects of a gluten-free diet on glycemic control and weight gain in subjects with type 1 diabetes and celiac disease”. Diabetes Care 7 (2002): 1117-1122.
33. Bardella MT., et al. “Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet”. The American Journal of Clinical Nutrition4 (2000): 937-939.
34. Saukkonen T., et al. “Coeliac disease in children and adolescents with type 1 diabetes: a study of growth, glycaemic control, and experiences of families”. Acta Paediatrica3 (2002): 297-302.
35. Barrett JS., et al. “Dietary poorly absorbed, short‐chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon”. Alimentary Pharmacology and Therapeutics8 (2010): 874-882.
36. El-Salhy M., et al. “Dietary fiber in irritable bowel syndrome”. International Journal of Molecular Medicine 3 (2017): 607-613.
37. Murray JA., et al. “Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease”. The American Journal of Clinical Nutrition4 (2004): 669-673.
38. Mustalahti K., et al. “Gluten-free diet and quality of life in patients with screen-detected celiac disease”. Effective Clinical Practice 3 (2002): 105-113.
39. Midhagen G and Hallert C. “High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study”. The American Journal of Gastroenterology9 (2003): 2023-2026.
40. Pulido O., et al. “Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease”. Canadian Journal of Gastroenterology (2013): 27.

Citation

Citation: Zahra Setavand., et al. “Anthropometric Indices and Clinical Manifestations After Gluten Free Diet Therapy and Nutritional Education in Pediatric Patients with Celiac Disease".Acta Scientific Nutritional Health 7.7 (2023): 79-84.

Copyright

Copyright: © 2023 Maryam Ekramzadeh., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.