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    Study Finds High Malnutrition and Mortality Rates Among Patients Hospitalized for Celiac Disease

    Reviewed and edited by a celiac disease expert.

    A new study assesses rates of malnutrition in hospitalized celiac patients, and looks at the impact of those hospitalizations.

    Celiac.com 09/05/2023 - Celiac disease is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. A team of researchers recently assessed the impact of malnutrition on in-hospital outcomes in patients with celiac disease.

    This study analyzed data from the National Inpatient Sample Database, encompassed 187,310 patients with celiac disease. The team included patients with a primary discharge diagnosis of celiac disease between January 2016 and December 2019 from the National Inpatient Sample Database. Data included patient demographics, hospital characteristics, the Charlson Comorbidity Index, and concomitant comorbidities. The association between malnutrition and outcomes, including mortality, deep vein thrombosis, pulmonary embolism, sepsis, acute kidney injury, length of stay, and total hospitalization charges, was analyzed using the multivariate regression model.

    Malnutrition Rate Among Hospitalized Celiacs at 8.3% and 108% Increase in Mortality Rate

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    The rate of malnutrition among celiac patients was found to be 8.3%, aligning with similar rates seen in prior research. However, this study adds new insights by demonstrating the link between malnutrition and various detrimental outcomes in hospitalized celiac patients.

    The research reveals that malnourished celiac patients are at a significantly higher risk of in-hospital mortality and resource utilization, as well as a range of complications including deep vein thrombosis, sepsis, acute kidney injury, and prolonged length of stay. The heightened mortality risk is particularly alarming, with a staggering 108% increase in mortality rates observed in malnourished celiac patients.

    The complex pathophysiology behind malnutrition in celiac disease involves factors like intestinal damage-induced malabsorption and chronic diarrhea. Common nutritional deficiencies in celiac patients encompass iron, zinc, folic acid, vitamin B12, vitamin D, and calcium. Despite these challenges, many celiac patients display malnutrition-related symptoms.

    Malnutrition was also associated with an increased risk of deep vein thrombosis, suggesting that diet could influence thrombosis-related factors. Additionally, acute kidney injury was more likely to develop in malnourished celiac patients, possibly due to dehydration and reduced serum creatinine levels. Sepsis, a serious condition, was found to be 43% more likely in patients with malnutrition, linked to their lower immunity caused by inadequate dietary intake.

    The study underscores the significance of proper nutrition in celiac patients, both for mitigating immediate complications and preventing long-term adverse effects. However, the study's limitations highlight the need for further investigation into factors such as disease severity, pharmaceutical therapies, and treatment compliance. 

    The findings emphasize the importance of a multidisciplinary approach to manage malnutrition in celiac patients, involving nutritional screening, medical therapy, and dietary recommendations, as well as interventions like enteral or parenteral nutrition. 

    Lastly, the research highlights the need for further investigations into factors contributing to malnutrition in celiac disease, and the effectiveness of interventions to address it.

    Read more in cureus.com

     

    The researchers included Kanwal Bains, Shivam Kalra, Ishandeep Singh, Jay Patel, Isha Kohli, Mukul Dhiman, Dino Dukovic, Aalam Sohal, and Avin Aggarwal. They are variously affiliated with the department of Internal Medicine, University of Arizona College of Medicine, Tucson, USA; the department of Internal Medicine, Trident Medical Center in North Charleston, USA; the department of Internal Medicine, Dayanand Medical College and Hospital in Punjab, IND; the Digestive Disease and Surgical Institute, Cleveland Clinic in Cleveland, USA; the department of Public Health Sciences, Icahn School of Medicine at Mount Sinai in New York , USA; the Internal Medicine, Punjab Institute of Medical Sciences in Punjab, IND; the department of Internal Medicine, Ross University School of Medicine in Bridgetown, BRB; and the department of Internal Medicine, UCSF Fresno in Fresno, USA.



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    Guest Connie

    In my case, gastro paresis appears to be the primary culprit when it comes to malnutrition. I cannot eat fiber without severe stomach pain and distress. I always have a stomach ache, and/or nausea anyway. Always. Therefore I can eat no roughage - no fiber - no fruits and no vegetables. I think there are more people like me than expected, who can't take vitamins, supplements, or even fish oil. Part of this abdominal distress is due to prescribed hormones that damaged my stomach. Also PPI' s.

    They have caused great trouble for me.

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    Val Armini
    13 hours ago, Guest Connie said:

    In my case, gastro paresis appears to be the primary culprit when it comes to malnutrition. I cannot eat fiber without severe stomach pain and distress. I always have a stomach ache, and/or nausea anyway. Always. Therefore I can eat no roughage - no fiber - no fruits and no vegetables. I think there are more people like me than expected, who can't take vitamins, supplements, or even fish oil. Part of this abdominal distress is due to prescribed hormones that damaged my stomach. Also PPI' s.

    They have caused great trouble for me.

    Gastroparesis has been a long-term issue for me also, severe pain from bloating.  eat about 2 bites at a time so that helps nausea.  Fluids are not excreted for long periods of time, with constipation resulting.   Limiting/avoiding gluten is helpful as it is definitely an irritant.  

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    Wheatwacked
    On 9/13/2023 at 12:57 AM, Guest Connie said:

    gastro paresis appears to be the primary culprit when it comes to malnutrition.

    Gastroparesis is the result of malnutrition. Low D, low Thiamine, low Choline and hyper vitamin E have been  identified as a possible cause of gastropresis.  Hyper vitamin E can be caused by low D.  Celiac Disease can cause malabsorption and if left uncorrected can lead to malnutrition; something doctors are not equipted to treat.

    Most doctors don't seem to know it though.

    Approximately 40% Americans, Canadians, British and Irish have low D or are outright deficient.

    90% eating western style diet do not meet the minimum recommedations for Choline.  High homocysteine may be an indicator of not enough choline, B12, folate or B6.

    Recent studies show that Thiamine deficiency may also affect heretofore unsuspected populations, and that the scope of disorders, including some long-lasting neurocognitive consequences, is broader than previously thought.

    High B6 can be caused by low D.

    Celiac caused malabsorption. Unrecognized malabsorption leads to malnutrion.  Malnutrition can cause gastroparesis. Vicious circle.

    Sorry to say but by convincing you that gastroparesis is not linked to your nutritional absorption status your doctor is condemning you.

    Edited by Wheatwacked
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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. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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