Compromised nutritional status of adults with celiac disease on a gluten free diet

Abstract

Introduction Investigating the nutritional status of individuals with Celiac Disease (CD) in the Middle East is warranted. Reasons for this include the reported disease prevalence, poor public awareness about CD, and lack of food regulations for the production and inspection of gluten-free labelled products.

Objectives To assess the dietary intake and body composition including bone mineral density (BMD) of Lebanese adults with CD following a gluten-free diet (GFD).

Methods We conducted a case-control study, whereby two healthy control adults were matched for age and sex with each CD subject. A preliminary sample of 19 adults with CD (age = 30 ± 3 years; 58 % females) and 32 control subjects (age = 27 ± 2 years; 50 % females) were recruited. Weight and height were measured using standard procedure. Body composition including body fat, lean body mass and bone mineral content and density (total body, hip and spine) were assessed using dual energy x-ray absorptiometry (DXA, Prodigy, GE Healthcare). To assess dietary intake, three-day food records were collected and analysed using Nutritionist Pro software (version 3.2, AXXYA).

Results Subjects with CD had significantly (p < 0.05) lower weight, Body Mass Index (BMI) and fat mass (63.3 ± 3.0 Kg; 22.2 ± 0.8 Kg/m2; 17.8±2.0 Kg, respectively) compared to controls (25.7 ± 0.7 Kg; 25.7 ± 0.7 Kg/m2, 24.7 ± 1.9 Kg, respectively). Total body and spine (L1–14) BMD of CD subjects were 14 % and 6 % lower than those of controls (p < 0.05). Dietary assessment revealed significantly lower thiamin and folate intake among subjects with CD.

Conclusions In line with the literature, Lebanese adults with CD have significantly lower BMI, fat mass and BMD compared to controls, while their diet is low in thiamine and folate. These results could be due to the inherent poor quality of GFD, lack of awareness about disease management and potential gluten contamination in their diet due to the absent food regulations for gluten-free products in Lebanon. These findings thus highlight the need for further investigations on this matter to eventually guide public policy development.