Nutrition and Bone Health in Adults With Probable Undiagnosed, Untreated Celiac Disease

Celiac.com 10/28/2019 - Among other things, a recent study on nutrition and bone health in adults with probable undiagnosed, untreated celiac disease drives home the importance of early diagnosis and quick adoption of a gluten-free diet. The importance can be seen in the findings of a research team that recently looked at variations in nutritional intake of calcium, vitamin D, and phosphorus; their levels in the blood; and bone health in adults with and without likely, undiagnosed celiac disease.

The research team included Lara H. Sattgast, Sina Gallo, Cara L. Frankenfeld, Alanna J. Moshfegh, and Margaret Slavin. They are variously affiliated with the Department of Nutrition & Food Studies, George Mason University, Fairfax, Virginia, USA; the Department of Global & Community Health, George Mason University, Fairfax, Virginia, USA; and the Food Survey celiac diseases Research Group, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland, USA.

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The team analyzed data from 48 adults with likely undiagnosed celiac disease and positive immunoglobulin A endomysial antibody tests, and 13,634 controls. The data came from What We Eat in America and the National Health and Nutrition Examination Survey 2009–2014, and included self-reported information on dietary and supplement intake from a single day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry images.

The team's statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio.

Rates of likely undiagnosed celiac disease were 1 in 285. Patients with likely celiac disease showed an average 251.6 mg higher daily total calcium intake, higher dairy consumption by 0.7 cups per day, and higher serum phosphorus levels. Probable celiac patients showed a substantially higher total dietary and supplement intake measured in calcium density and phosphorus density. 

The researchers saw no differences in serum calcium, vitamin D, or alkaline phosphatase levels between the groups. Patients with likely celiac disease were associated with lower femur bone mineral density (BMD) and a lower femoral neck BMD, but showed no difference in total spine BMD.

This is one of the first studies to examine variations in nutritional intake of calcium, vitamin D, and phosphorus; their levels in the blood; and bone health in adults with and without likely, undiagnosed celiac disease.

Adults with probable undiagnosed celiac disease had lower bone density than those without celiac disease, even though they reported higher calcium intake and nutritional density of calcium and phosphorus. Among other things, the variations in BMD in this study demonstrate the importance of early diagnosis and the rapid adoption of a gluten-free diet for patients with undiagnosed celiac disease.

Read more in the J Am Coll Nutr. 2019 Jul 19:1-10.