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  • Jefferson Adams
    Jefferson Adams

    Celiac Disease Screening Among a Large Cohort of Overweight/Obese Children

    Reviewed and edited by a celiac disease expert.

    Celiac.com 03/10/2015 - Up to now, celiac disease has been described only in sporadic cases of obesity. A research team recently set out to evaluate retrospectively celiac disease rates in a large group of overweight/obese children and adolescents.

    Photo: CC--GaulsstinThe research team included Raffaella Nenna, Antonella Mosca, Maurizio Mennini, Raffaele E. Papa, Laura Petrarca, Roberta Mercurio, Monica Montuori, Alessandra Piedimonte, Maria Bavastrelli, Ilaria C. De Lucia, Margherita Bonamico, and Andrea Vania.



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    For their study, the team consecutively evaluated 1,527 overweight/obese children and adolescents, 10 girls and 7 boys had positive celiac serology and showed villous atrophy.

    All celiac patients immediately began a well-balanced gluten-free diet, and rapid weight loss followed.

    The study shows that celiac rates in overweight/obese children are similar to rates in the general Italian pediatric population, and that those children benefit from proper diagnosis and a healthy gluten-free diet.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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  • Related Articles

    Scott Adams
    Celiac.com 11/29/2006 – Contrary to popular beliefs (not to metion outdated medical training), this study demonstrates that 39% of those who are diagnosed with celiac disease are actually overweight rather than underweight. A full 30% of celiac disease patients were in the obese range at the time of their diagnosis. Unfortunately many medical doctors still wont even consider testing overweight patients for celiac disease because they erronously believe that the disease can only occur in individuals who are underweight. This line of reasoning is outdated and incorrect, and is also very dangerous to those who happen to have celiac disease are are overweight—which is now known to be quite common.
    For those who want to read more about this topic be sure to have a look at the following articles:
    Celiac Disease and Obesity—There is a Connection by Melissa Croda Food Cravings, Obesity and Gluten Consumption by Dr. Ron Hoggan, Ed.D.
    Below is the Abstract for the latest study, which was conducted by William Dickey, M.D., Ph.D., F.A.C.G.:

    Am J Gastroenterol. 2006;101(10):2356-2359.
    Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet
    Posted 11/14/2006
    William Dickey, M.D., Ph.D., F.A.C.G.; Natalie Kearney, B.Sc. Abstract:

    Background: It is well established that a minority of celiac patients present with classic symptoms due to malabsorption. However, few studies have focussed on the distribution of body mass index (BMI) in celiac populations and its relationship to clinical characteristics, or on its response to treatment.
    Methods: We reviewed BMI measurements and other clinical and pathological characteristics from a database of 371 celiac patients diagnosed over a 10-yr period and seen by a single gastroenterologist. To assess response to gluten exclusion, we compared BMI at diagnosis and after 2 yr treatment in patients with serological support for dietary compliance.
    Results: Mean BMI was 24.6 kg/m2 (range 16.3–43.5). Seventeen patients (5%) were underweight (BMI Conclusions:
    Few celiac patients are underweight at diagnosis and a large minority is overweight; these are less likely to present with classical features of diarrhea and reduced hemoglobin. Failed or delayed diagnosis of celiac disease may reflect lack of awareness of this large subgroup. The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.


    Jefferson Adams
    Celiac.com 10/11/2010 - People who follow a gluten-free diet solely for the purposes of losing weight may be setting themselves up for failure.
    For people with celiac disease and gluten intolerance, following a gluten-free diet is both necessary and beneficial from a medical standpoint. People with celiac disease or gluten sensitivity must not eat the gluten proteins found in wheat, rye, and barley.
    For people with celiac disease, eating even minute traces of gluten can trigger an autoimmune reaction damages the lining the small intestine. An estimated three million Americans have celiac disease—and the vast majority remain undiagnosed because the symptoms can vary or mimic other diseases.
    Symptoms commonly include bloating, gas, diarrhea and constipation, as well as early osteoporosis. People with celiac disease also suffer high rates of skin rashes, chronic fatigue, bone and joint pain, neurological problems, liver problems, diabetes, infertility in both men and women and cancers, including lymphoma.
    Rates of celiac disease are up 400% in the last 50 years, and, according to the Archives of Internal Medicine Clinical Gastroenterology and Hepatology, celiac disease diagnoses have increased 20-fold since 1989. Some doctors think gluten sensitivity could affect up to 10% of the population.
    Until now, doctors diagnosed gluten sensitivity mainly by ruling out celiac disease in people who show symptoms. But researchers are looking more and more at antibodies to gliadin, a gluten component, as a possible biomarker. About 7% of people have these anti-gliadin antibodies (AGA); interestingly, so do 18% of people with autism, and 20% of people with schizophrenia, according to studies by Dr. Alessio Fassano.
    These numbers, coupled major advances in diagnosis, greater awareness among doctors and better information sharing among those affected, have made for rapid expansion of the gluten-free food markets, and great buzz on the part of manufacturers, advertisers, retailers, and consumers.
    That's made for an explosion of new gluten-free products on the food market in the last few years. All of this buzz may tempt many to wonder what it's all about, and if eliminating gluten can provide benefits, such as losing weight.
    For some, gluten-free foods have become a new health craze, with promises of a slimmer, fitter, healthier body for those who go gluten-free. Sounds great, right? Just stop eating wheat and gluten and get slim and healthy and live happily-ever-after.
    Not so fast.
    A gluten-free diet is simply not for everyone. For some, depending on what kind of gluten-free foods they eat, going gluten-free may have the opposite effect. A gluten-free diet will not automatically help people lose weight or avoid carbohydrates.
    "Many packaged gluten-free products are even higher in carbs, sugar, fat and calories than their regular counterparts, and they tend to be lower in fiber, vitamins and iron," says Shelley Case, a registered dietician on the medical advisory board of the Celiac Disease Foundation. Gluten-free does not automatically mean nutritious, she notes.
    Gluten is not only a key ingredient in baked goods. It's also used as a thickening agent in ketchup and ice cream. But, just like their regular, gluten-containing counterparts, gluten-free products like cake, brownie and cookie mixes are often high in fat and calories. For example, a serving of regular pasta provides 41 grams of carbohydrates, compared to 46 grams for a similar gluten-free pasta.
    So, most experts agree that a gluten-free diet is both necessary and beneficial for those with celiac disease and gluten-intolerance. In such cases, avoiding gluten with usually help people to stabilize and reverse either weight gain, or loss, depending on the case. Otherwise, there's no scientific evidence to suggest that adopting a gluten-free diet is a good way to lose weight.
    These and other valuable insights into gluten-free diet can be found in Emily Beckman's full-length article for The Wall Street Journal.



    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.
    The 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:
    Alimentary Pharmacology & Therapeutics. 2012;35(6):


    Jefferson Adams
    Celiac.com 03/04/2013 - Morbid obesity is a common medical condition. In many cases, bariatric surgery is necessary. Although for decades celiac disease has been associated with chronic diarrhea and weight loss, and other classic symptoms, recent data shows that the clinical spectrum of celiac disease is extremely wide.
    A group of researchers recently reported on the benefits of diagnosing celiac disease during pre-operative work-up for bariatric surgery.
    The researchers included Federico Cuenca-Abente, Fabio Nachman, and Julio C. Bai of the Department of Surgery and Department of Medicine at Dr C. Bonorino Udaondo Gastroenterology Hospital in Buenos Aires, Argentina.
    They reported on the cases of five morbidly obese patients diagnosed with celiac disease during preoperative work-up for bariatric surgery. Celiac disease was suspected upon routine upper endoscopy, and confirmed by histology and positive celiac disease-specific blood tests.
    Interestingly, four of the five patients had no obvious symptoms. One complained of chronic diarrhea and anemia. All patients began a gluten-free diet. Due to their celiac disease diagnosis, doctors offered all five patients a purely restrictive bariatric procedure. At the time of the report, three of the patients had received a sleeve gastrectomy, while the other two were still undergoing pre-operative evaluation.
    The team's findings help to enlarge the clinical spectrum of untreated celiac disease. Even though rates of celiac disease in obese patients seems to be similar to that in the general population, the team recommends that patients with morbid obesity be tested for celiac disease in order to determine the best surgical strategy and outcome.
    Source:
    Acta Gastroenterol Latinoam 2012;42:321-324


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