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Celiac.com 12/09/2013 - People with celiac disease commonly suffer malabsorption, weight loss and vitamin/mineral-deficiencies. A team of researchers recently set out to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult celiac disease patients in the Netherlands. The research team included Nicolette J. Wierdsma, Marian A. E. van Bokhorst-de van der Schueren, Marijke Berkenpas, Chris J. J. Mulder, and Ad A. van Bodegraven. They are affiliated with the Department of Nutrition and Dietetics and the Department of Gastroenterology at Celiac Centre Amsterdam in VU University Medical Centre in Amsterdam, The Netherlands. Researchers assessed 80 newly diagnosed adult celiac patients, averaging 42.8 years old, ± 15.1 years. They compared vitamin concentrations for those patients against a sample of 24 healthy Dutch subjects. Before prescribing gluten-free diets to the patients, the researchers assessed nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin. Almost nine out of ten celiac patients (87%) measured at least one value below the lowest normal reference levels. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, 67% of celiac patients showed zinc deficiency, 46% showed decreased iron storage, and 32% had anaemia. Overall, 17% of celiac patients were malnourished, with more than 10% experiencing undesired weight loss, 22% of the women underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients overweight (BMI > 25). Vitamin deficiencies were nearly non-existent in healthy control subjects, though they did show some vitamin B12 deficiency. Interestingly, vitamin and or mineral deficiencies were not associated with greater histological intestinal damage or with adverse nutritional status. This study shows that vitamin and/or mineral deficiencies are still common in newly “early diagnosed” celiac patients, even as rates of obesity upon initial celiac diagnosis continue to rise. Thorough nutritional monitoring is likely warranted for establishing a dietary baseline and maintaining nutritional levels during the course of celiac disease treatment. Source: Nutrients 2013, 5(10), 3975-3992; doi:10.3390/nu5103975
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Celiac.com 07/12/2012 - A research team affiliated with the Department of Endocrinology and Nutrition at Complejo Hospitalario Mancha Centro in Alcázar de San Juan, Spain, recently set out to study how bone mineral density correlates with duodenal Marsh stage in newly diagnosed adult celiac patients. The team made up of A. García-Manzanares, J.M. Tenias, and A.J. Lucendo. For their study, the researchers wanted to estimate the rates of low bone mineral density (BMD) in adult celiac patients and to better understand nutritional and metabolic factors associated with osteoporosis and osteopenia. To do so, they recruited patients a consecutive group of 40 adults (36 females/4 males), between the ages of 18 and 68, who were newly diagnosed with celiac disease. Average patient age was 44.25 years. For each patient, the researchers conducted bone density scans on the left hip and lumbar spine using dual-energy X-ray absorptiometry. They also assessed nutritional parameters and conducted a hormone study to exclude secondary low BMD. Overall, at diagnosis 45% of patients showed low BMD at both hip and lumbar spine. Risk of hip fracture was generally low, but climbed into the mild range for patients with villous atrophy (p = 0.011). The team also found that major fracture risk varied according to Marsh stage (p = 0.015). They found significant differences in nutritional status between patients with and without duodenal villous atrophy. Marsh III stage patients showed substantially reduced body mass index and blood levels of pre-albumin, iron, vitamin D and folic acid. The team found no differences found in blood hormone levels between Marsh stages or BMDs. They found that the amount of bone mass loss in the lumbar spine was directly tied to Marsh stage. They found a parallel association between BMD and Marsh stage in the hip, but this was not statistically significant. Overall, results showed that duodenal villous atrophy, through malabsorption, was the main factor for low BMD in patients with adult-onset celiac disease. Source: Scand J Gastroenterol. 2012 May 16.
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Celiac.com 05/02/2012 - Doctors and researchers are still debating the usefulness of active blood screening for spotting celiac disease in older populations. Studies do suggest that many cases of celiac disease go undetected, especially in the older population. One unanswered question is whether screening does any good for older people who have been eating gluten many decades. A team of researchers recently studied the clinical benefit of a gluten-free diet in screen-detected older celiac disease patients. The research team included Anitta Vilppula, Katri Kaukinen, Liisa Luostarinen, Ilkka Krekelä, Heikki Patrikainen, Raisa Valve, Markku Luostarinen, Kaija Laurila, Markku Mäki, and Pekka Collin. They are affiliated with the Department of Neurology, the Department of Internal Medicine and the Department of Surgery at Päijät-Häme Central Hospital, and the University of Helsinki's Department of Education and Development in Lahti, Finland, the Department of Gastroenterology and Alimentary Tract Surgery the School of Medicine, and the Paediatric Research Centre at the University of Tampere and Tampere University Hospital, Tampere, Finland. For their study, the researchers evaluated the benefit of active detection and implementation of a gluten-free diet in elder populations with for celiac disease. The team evaluated thirty-five biopsy-proven celiac patients over 50 years of age, each of whom had celiac disease detected by mass blood screening. They looked at bone mineral density, dietary compliance, disease history, quality of life, and symptoms at baseline and after 1-2 years of a gluten-free diet. They also looked at small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density. Using surveys, the team established gastrointestinal symptom ratings and quality of life by psychological general well-being. The used this information to rate symptoms. They found patient dietary compliance to be good overall. Initial tests on the patients showed reduced serum ferritin levels, pointing to subclinical iron deficiency. This trend reversed after patients followed a gluten-free diet. Initially low vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on a gluten-free diet. Patient histories showed that those with celiac disease had sustained more low-energy fractures, and sustained such fractures more frequently than the general population. A gluten-free diet brings with it a beneficial increase in bone mineral density. The team also noticed that many gastrointestinal symptoms disappeared, even though though many patients reported only subtle symptoms upon diagnosis. Quality of life remained unchanged. According to the study team, two out of three patients would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been factored in. Results showed that patients who had celiac disease detected by mass blood screen did, in fact, benefit from a gluten-free diet. For doctors evaluating older patients, the team advocates a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening. Source: BMC Gastroenterology 2011, 11:136. doi:10.1186/1471-230X-11-136
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Celiac.com 09/13/2010 - What's happening in with the immune system when a child is first diagnosed with celiac disease? What happens when they are treated with a gluten-free diet? Some recent studies have indicated that both the adaptive and the innate immune system play roles in celiac disease. However, until now, doctors haven't known much about the immune phenotype of children with celiac disease and how that phenotype might by affected by a gluten-free diet. To move toward a better understanding of these issues, a team of researchers recently studied immune phenotype in children with either newly diagnosed celiac disease, or celiac disease treated with a gluten-free diet. The research team included Áron Cseh, Barna Vásárhelyi, Balázs Szalay, Kriszta Molnár, Dorottya Nagy-Szakál, András Treszl, Ádám Vannay, András Arató, Tivadar Tulassay and Gábor Veres. The are affiliated with the First Department of Pediatrics in the Research Group for Pediatrics and Nephrology at Semmelweis University and Hungarian Academy of Sciences, in Budapest, Hungary. For their study, the team described the status of major players within the adaptive and innate immune system in peripheral blood of children with newly diagnosed celiac disease. They then looked to see how the phenotype might have changed once the symptoms improved following treatment with a gluten-free diet. The team drew peripheral blood samples from ten children with biopsy-proven celiac disease at the time of diagnosis and again after once clinical symptoms subsided with treatment by gluten-free diet. They also drew blood samples from a control group of 15 children who suffered from functional abdominal pain. They measured the prevalence of cells of adaptive and innate immunity by means of labeled antibodies against surface markers and intracellular FoxP3 using a flow cytometer. They found that patients with celiac disease had lower T helper, Th1 and natural killer (NK), NKT and invariant NKT cell prevalence and with higher prevalence of activated CD4+ cells, myeloid dendritic cells (DC) and Toll-like receptor (TLR) 2 and TLR-4 positive DCs and monocytes compared to controls. Most of these deviations returned to normal, once symptoms subsided with gluten-free diet treatment. However, prevalence of NK and NKT cell, DC and TLR-2 expressing DCs and monocytes remained abnormal. The immune phenotype in childhood celiac disease indicates that both adaptive and innate immune systems are playing a role in celiac disease. Treatment with a gluten-free diet reverses immune abnormalities, but the mechanics of the reversal likely varies among cell types. Source: Dig Dis Sci. 2010 Aug 5. DOI: 10.1007/s10620-010-1363-6
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Celiac.com 12/16/2009 - Research has suggested potential autoimmune involvement of the pituitary gland in patients with celiac disease, but such activity has only been shown in only a few patients on gluten-free diet. A team of researchers recently set out to assess the prevalence and clinical meaning of anti-pituitary antibodies (APA) in children and adolescents with the newly diagnosed celiac disease. The research team was made up of M. Delvecchio, A. De Bellis, R. Francavilla, V. Rutigliano, B. Predieri, F. Indrio, D. De Venuto, A. A. Sinisi, A. Bizzarro, A. Bellastella, L. Iughetti, and L. Cavallo. They are affiliated with the Unità Operativa Complessa di Pediatria, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy. The team set out to assess the prevalence and clinical meaning of anti-pituitary antibodies (APA) in children and adolescents with the newly diagnosed celiac disease. For their cross-sectional study, the team recruited atonal of 119 patients with celiac disease from the inpatient clinic of University Hospital. Test subjects ranged from 0.9 to 15.8 years in age. Clinicians recorded their height, weight, and body mass index (BMI), and assayed their insulin-like growth factor-1 (IGF-1) and APA. Researchers determined APA in 98 sex- and age-matched control subjects. They found APA in 50 of those subjects (42.0%), 15 of whom showed high titer (30%), 35 showed low titer (70%), and 2 control subjects showed low titer (2%) (P<0.001). More patients with negative than with low titer (P=0.02) or high titer APA (P=0.03) showed higher IGF-1. High-titer APA patients showed more reduced height than did negative ones (P<0.01). Researchers positively correlated height with IGF-1 (P<0.01) and negatively with chronological age (P=0.001). They positively correlated IGF-1 with BMI (P<0.001). For height prediction the regression analysis showed the rank order 1 for chronological age and 2 for IGF-1. This results of this study demonstrate a substantial prevalence of positive APA in newly diagnosed celiac disease patients. High APA titers are associated with reduced height impairment, likely mediated by a reduction of IGF-1, thus indicating that autoimmune pituitary process may induce a linear-growth impairment. Source: Am J Gastroenterol advance online publication, 10 November 2009; doi:10.1038/ajg.2009.642.
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Celiac.com 02/20/2009 - Doctors are recommending screening for bone density in children with newly diagnosed celiac disease. A team of researchers recently set out to evaluate children with celiac disease for bone deficits in spine (SP) and whole body (WB) bone mineral content (BMC) at time of diagnosis, and to evaluate whether such deficits are associated with deviations in growth and body composition. Additionally, the team sought to assess the effect of histological grade on BMC. The research team was made up of doctors Muralidhar Jatla, Zemel, S. Babette, Patricia Bierly, and Ritu Verma associated with the Department of Pediatrics, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Their study was supported by the Nutrition Center at the Children's Hospital of Philadelphia and the Clinical and Translational Research Center from Clinical and Translational Science Award UL1-RR0241340. Their findings were reported in a recent issue of Gastroenterology. The team conducted a retrospective study that compared the results of children who had undergone a dual energy x-ray absorptiometry scan at the time of their celiac disease diagnosis against a healthy reference sample matched for age, race and geographic region in the United States. All celiac disease diagnosis occurred between October 1, 2003, and June 15, 2006. To evaluate differences between the celiac disease and the control group, the research team expressed SP and WB BMC as sex-specific z scores relative to age and relative to height. They performed Pearson correlation, t tests, and analysis of variance to assess predictors of BMC. They evaluated a total of forty-four children with celiac disease and compared them with 338 healthy controls. The celiac children averaged 10.6 ± 3.4 years of age, were 77% female, and 96% white. The children with celiac disease were shorter than their healthy counterparts of similar age, sex and region. The children with celiac disease also showed significantly lower SP and WB BMC for age z scores compared with controls. The children with celiac showed significant deficits in WB BMC, even once the figures were adjusted for height. Low SP and WB BMC were associated with advanced histological grade in celiac disease. Low body mass index was associated with low WB BMC in celiac disease. The research team concluded that screening for low bone mineral content may benefit children who are newly diagnosed with celiac disease, as those with low body mass index and those with advanced histological damage (Marsh grade IIIc) face an elevated risk of osteopenia. Journal of Pediatric Gastroenterology and Nutrition:Volume 48(2)February 2009p 175-180
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Alimentary Pharmacology & Therapeutics Volume 17 Issue 4 Page 587 - February 2003 Aliment Pharmacol Ther 2003 Feb;17(4):587-94 Peraaho M, Kaukinen K, Paasikivi K, Sievanen H, Lohiniemi S, Maki M, Collin P. Departments of Medicine and Pediatrics, Tampere University Hospital, Tampere (also Medical School, University of Tampere), Bone Research Group, UKK Institute, Tampere, and Finnish Coeliac Society, Tampere, Finland. Celiac.com 3/14/2003 - BACKGROUND: : The safety of wheat-starch-based gluten-free products in the treatment of coeliac disease is debatable. Prospective studies are lacking. AIM: : To compare the clinical, histological and serological response to a wheat-starch-based or natural gluten-free diet in patients with newly detected coeliac disease. METHODS: : Fifty-seven consecutive adults with untreated coeliac disease were randomized to a wheat-starch-based or natural gluten-free diet. Clinical response, small bowel mucosal morphology, CD3+, alphabeta+ and gammadelta+ intraepithelial lymphocytes, mucosal human leucocyte antigen-DR expression and serum endomysial, transglutaminase and gliadin antibodies were investigated before and 12 months after the introduction of the gluten-free diet. Quality of life measurements were performed by standardized questionnaires and the bone mineral density was analyzed. RESULTS: : In both groups, abdominal symptoms were alleviated equally by a strict diet. There were no differences between the groups in mucosal morphology, the density of intra-epithelial lymphocytes, serum antibodies, bone mineral density or quality of life tests at the end of the study. Four patients on a natural gluten-free diet and two on a wheat-starch-based gluten-free diet had dietary lapses; as a result, inadequate mucosal, serological and clinical recovery was observed. CONCLUSIONS: : The dietary response to a wheat-starch-based gluten-free diet was as good as that to a natural gluten-free diet in patients with newly detected coeliac disease. PMID: 12622768
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