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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    HIGHER BODY MASS INDEX AND LOWER RISK OF OBESITY IN CELIAC DISEASE PATIENTS ON A GLUTEN-FREE DIET


    Jefferson Adams

    Celiac.com 05/25/2012 - A team of researchers recently set out to examine body mass and obesity risk in a large population of people with celiac disease who are following a gluten-free diet.


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    Photo:CC-FBellonThe research team included T. A. Kabbani, A. Goldberg, C. P. Kelly, K. Pallav, S. Tariq, A. Peer, J. Hansen, M. Dennis & D. A. Leffler. They are affiliated with the Department of Medicine and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

    Diagnosis for celiac disease is on the rise, and many people who are diagnosed experience weight changes once they adopt a gluten-free diet. There's a pretty good amount of study data on weight change on a gluten-free diet, but a very limited amount of data regarding changes in body mass.

    The researchers wanted to look at a large population of people with celiac disease, who followed a gluten-free diet to better understand changes in body mass index (BMI) following celiac diagnosis.

    To do this, they looked at a total of 1018 patients with biopsy confirmed celiac disease. The patients had all previously visited the Beth Israel gastroenterology clinic in Boston.

    The team recorded data for initial and follow-up BMIs, and used an expert dietitian to assess patient compliance with a gluten-free diet. They found a total of 679 patients with at least two recorded BMIs and GFD adherence data, and used data from those patients in their study. The average amount of time from first BMI measurement to follow-up measurement was 39.5 months.

    When they compared the results against data for the general population, they found that celiac disease patients on a gluten-free diet were significantly less likely to be overweight or obese (32% vs. 59%, P < 0.0001).

    They also found that average body mass increased significantly after patients adopted a gluten-free diet (24.0 to 24.6; P < 0.001). Overall, 21.8% of patients with normal or high BMI at study entry increased their BMI by more than two points.

    The results of this study show that celiac disease patients on a gluten-free diet have lower BMI than the regional population at diagnosis, but that BMI increases with a gluten-free diet, especially in those who follow the diet closely.

    Still, even though overall risk of obesity is lower than the regular population, once celiac patients adopt a gluten-free diet, 15.8% of patients move from a normal or low BMI class into an overweight BMI class, and 22% of patients overweight at diagnosis gain weight.

    As a result, the study team feels that weight maintenance counseling should be an integral part of celiac dietary education.

    Source:


    Image Caption: Photo:CC-FBellon
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    Guest Jennifer

    Posted

    This article is an unnecessary obesity scare tactic. BMI is bunk, so this article has no merit. It doesn't mention that half of adults are overweight at diagnosis (because it would nullify this study).

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    Guest marketing@celiac.com

    Posted

    This article is an unnecessary obesity scare tactic. BMI is bunk, so this article has no merit. It doesn't mention that half of adults are overweight at diagnosis (because it would nullify this study).

    We actually covered that research as well: http://www.celiac.com/articles/22908/1/Nearly-Half-of-Patients-with-Celiac-Disease-are-Overweight-or-Obese-at-Diagnosis--/Page1.html

     

    I wouldn't say this research is any sort of obesity scare tactic though. It just shows that we still don't entirely understand how celiac disease affects the body, particularly body weight.

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    Guest sandy

    Posted

    I don't understand the body mass index. All I know is that my waist and stomach keep getting bigger and I can't seem to lose any weight.

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    Guest shaell

    Posted

    How come it doesn't mention that gluten-free food is way higher in sugar and fats to make food more palatable?

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    Guest Lara

    Posted

    This may speak, in part, to the higher fat and calorie content present in many of the gluten-free breads/baked goods.

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    Guest Lynn_M

    Posted

    I was diagnosed with non-celiac gluten sensitivity 6 months ago at age 64. No gluten since then, very few other grains, and barely any desserts, yet my weight stays unchanged at slightly overweight. Given the change in my eating habits, I'm astounded that I haven't lost weight. My experience parallels that of the research subjects.

     

    I wonder what the metabolic explanation is for persistent weight gain despite being gluten-free.

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    Guest gfistheonlyway

    Posted

    I was relieved to read this article. I was diagnosed 2 years ago with celiac disease, and after adapting to a gluten-free lifestyle, my weight jumped a lot. I have tried every diet and cannot seem to lose weight, the belly fat has really increased and I work out daily. I was glad to hear there are others who are struggling with this as well. Thank you for printing the study!

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    Guest ScooterMama

    Posted

    Learning, Learning, Learning. Thanks for the

    info. And yes, I'm one who was found to be

    overweight from celiac disease after 20 years, but I have

    definitely benefited from the gluten-free diet.

    Thanks again!

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    Guest BK Simmons

    Posted

    I would have liked a little info on how the gluten-free diet, which adds more "bread, rice, & other starches" into a celiac's diet causes a weight gain especially when their previous diet has limited these foods. Also how the medication(s) used in the management of the disease affects the weight gain.

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    Guest Don Brown

    Posted

    This article is an unnecessary obesity scare tactic. BMI is bunk, so this article has no merit. It doesn't mention that half of adults are overweight at diagnosis (because it would nullify this study).

    Hi all, well perhaps my personal experience may help. I self-diagnosed gluten sensitivity about 2 years back. My weight at that time was 234. My weight today is 234... changes. Yep, after removing all wheat products my body size started to change; it was almost to 3x. After 6 months, my size overall dropped to a large. I lost no weight but I felt much better. I'm 61 now and am at a size that feels better. I will start to lose some pounds soon, diet changes, but body mass dropped like a rock when I started eliminating wheat. Maybe others have had similar results. Have a good one.

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    Guest Renee

    Posted

    For those who haven't lost any weight, maybe you aren't eating enough food? It's important to fill your diet with healthy proteins and those grains that you are able to eat. For me, I eat a jumbo egg and veggie omelet with one corn tortilla, sprinkling of cheese, and salsa in the morning. Lunch is usually chicken with a green salad with some sort of nut and olives and a healthy dressing. Dinner is about the same: a healthy protein, lots of veggies, and a carb that I can handle. I've also done the 4-6 small meals a day when I have time. Gluten-free doesn't necessarily mean diet food. You still have to eat wisely and think portion-control. Which is why the eating small meals every 3 hours really is best.

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    Hi all, well perhaps my personal experience may help. I self-diagnosed gluten sensitivity about 2 years back. My weight at that time was 234. My weight today is 234... changes. Yep, after removing all wheat products my body size started to change; it was almost to 3x. After 6 months, my size overall dropped to a large. I lost no weight but I felt much better. I'm 61 now and am at a size that feels better. I will start to lose some pounds soon, diet changes, but body mass dropped like a rock when I started eliminating wheat. Maybe others have had similar results. Have a good one.

    So far, I've only been gluten-free (self-diagnosed celiac disease) for two months, and I have had similar results. Over the first month I decreased one dress size in volume though my weight stayed the same. As gluten-free bread, etc. is in general higher calorie, if the same amount is consumed after going gluten-free then weight is bound to rise. I'm 64 and feel so much better since going gluten-free. I would like to lose about 5 kilos eventually but will wait until I have been 6 months gluten-free to evaluate the changes. I find that I eat less bread, biscuits, etc. than before as the gluten-free ones are more filling and unless home-made, not very nice.

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    For those who haven't lost any weight, maybe you aren't eating enough food? It's important to fill your diet with healthy proteins and those grains that you are able to eat. For me, I eat a jumbo egg and veggie omelet with one corn tortilla, sprinkling of cheese, and salsa in the morning. Lunch is usually chicken with a green salad with some sort of nut and olives and a healthy dressing. Dinner is about the same: a healthy protein, lots of veggies, and a carb that I can handle. I've also done the 4-6 small meals a day when I have time. Gluten-free doesn't necessarily mean diet food. You still have to eat wisely and think portion-control. Which is why the eating small meals every 3 hours really is best.

    I totally agree with you, Renee.

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    Guest Michael

    Posted

    BMI is a defunct concept devised in the early 1800's. I am 5' 8". At the peak of my season my senior year in high school, I did three workouts per day 5 days a week and one long workout on Saturdays, swimming over 11,000 yards a day. I had a 29-30 inch waist, weighed between 165 and 170 lbs and had a body fat level of about 4% (too low really). I was not a runner but I could run for 7 miles non-stop, take a short break and then run 7 miles back home. You could not pinch any fat on my abdomen. It was skin over muscle. At age 45 I turned to lifting. I worked out 4-5 days a week, could bench press 325 lbs and squat 465 lbs. I had a 31-32 inch waist, weighed between 185 and 190 lbs and a body fat level of less than 10%. I could probably run about 5-6 miles one way. You could pinch a little bit more than skin on my abdomen, but I looked "cut" all over.

     

    According to the BMI chart, at 190 lbs, I was officially obese. Nonsense! I was in excellent condition. (I wish I was back there now.) If I followed their suggested weight level for a "normal" person, I would only weigh about 140 (or even less); that's Auschwitz material. The only proper way to determine a healthy weight for any given person is according to their LBM - lean body mass. Lean Body Mass is a component of your body composition, calculated by subtracting your body fat weight from your total body weight: total body weight is lean plus fat. Lean Body Mass equals Body Weight minus Body Fat. The correct rule should be: It's not how much you weigh, its how lean or fat you are. If you weigh 200 lbs and are 5' 8" but are only 10% body fat and you can jog/run 5+ miles without straining, chances are you're in great shape and great overall cardiovascular health.

     

    A toned and/or muscular body is both healthy and attractive. Being an emaciated scarecrow is not. And for the record, I have celiac disease. Watching what and when you eat certainly helps, but nothing can take the place of a proper exercise/workout regimen. No diet in the world can make you look tone or muscular, only exercise can do that.

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    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6