Skip to main content

Gluten-Free Diet: Nutritional Status and Dietary Habits of Celiac Patients

  • Chapter
  • First Online:
Nutritional and Analytical Approaches of Gluten-Free Diet in Celiac Disease

Abstract

The only effective treatment for celiac disease (CD) consists of a strict, lifelong, gluten-free diet (GFD), which means avoiding all products containing gluten. A GFD needs to be not only secure but also nutritionally balanced. However, when the nutritional composition of the GFDs of celiac patients was assessed, unbalanced proportions of macronutrients and several deficiencies in vitamin and mineral content were observed in adults, children, and adolescents. This chapter describes the nutritional status and dietary habits of celiac patients on GFDs and proposes strategies to achieve more balanced diets.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BMI:

Body mass index

CD:

Celiac disease

CH:

Carbohydrate

FFM:

Fat-free mass

FM:

Fat mass

GF:

Gluten-free

GFD:

Gluten-free diet

GFP:

Gluten-free product

ppm:

Parts per million

References

  1. Lasa A, Churruca I, Miranda J, Larretxi I, Bustamante MA, Simón E. Guía de alimentación equilibrada para las personas celiacas. Departamento de Salud de Gobierno Vasco, asociación de Celiacos de Euskadi y Laboratorio de Análisis de Gluten de la Universidad del País Vasco. 2014. ISBN: 978–84–695-9829-0.

    Google Scholar 

  2. Whitton C, Nicholson SK, Roberts C, Prynne CJ, Pot GK, Olson A, et al. National diet and nutrition survey: UK food consumption and nutrient intakes from the first year of the rolling programme and comparisons with previous surveys. Br J Nutr. 2011;106:1899–914.

    Article  CAS  Google Scholar 

  3. Størsrud S, Hulthén LR, Lenner RA. Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences. Br J Nutr. 2003;90:101–7.

    Article  Google Scholar 

  4. Enghardt BH, Pearson M, Becker W. Dietary habits and nutrient intake in Swedish children 4 years old and school children in grades 2 and 5 (Riksmaten – barn 2003). Uppsala: Uppsala, National Food Administration (Livsmedelsverket); 2006.

    Google Scholar 

  5. Miranda J, Lasa A, Bustamante MA, Churruca I, Simon E. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum Nutr. 2014;69:182–7.

    Article  CAS  Google Scholar 

  6. Thompson T. Thiamin, riboflavin, and niacin contents of the gluten-free diet: is there cause for concern? J Am Diet Assoc. 1999;99:858–62.

    Article  CAS  Google Scholar 

  7. Saturni L, Ferretti G, Bacchetti T. The gluten-free diet: safety and nutritional quality. Forum Nutr. 2010;2:16–34.

    CAS  Google Scholar 

  8. Pietzak MM. Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology. 2005;128(4 Suppl 1):S135–41.

    Article  Google Scholar 

  9. Valdimarsson T, Toss G, Löfman O, Ström M. Three years’ follow-up of bone density in adult celiac disease: significance of secondary hyperparathyroidism. Scand J Gastroenterol. 2000;35:274–80.

    Article  CAS  Google Scholar 

  10. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Forum Nutr. 2013;5:3975–92.

    Google Scholar 

  11. Malandrino N, Capristo E, Farnetti S, Leggio L, Abenavoli L, Addolorato G, et al. Metabolic and nutritional features in adult celiac patients. Dig Dis. 2008;26:128–33.

    Article  Google Scholar 

  12. Corazza GR, Di Sario A, Sacco G, Zoli G, Treggiari EA, Brusco G, et al. Subclinical celiac disease: an anthropometric assessment. J Intern Med. 1994;236:183–7.

    Article  CAS  Google Scholar 

  13. Capristo E, Mingrone G, Addolorato G, Greco AV, Corazza GR, Gasbarrini G. Differences in metabolic variables between adult celiac patients at diagnosis and patients on a gluten-free diet. Scand J Gastroenterol. 1997;32:1222–9.

    Article  CAS  Google Scholar 

  14. Bodé S, Hassager C, Gudmand-Høyer E, Christiansen C. Body composition and calcium metabolism in adult treated celiac disease. Gut. 1991;32:1342–5.

    Article  Google Scholar 

  15. Mazure RM, Vazquez H, Gonzalez D, Mautalen C, Soifer G, Cataldi M, et al. Early changes of body composition in asymptomatic celiac disease patients. Am J Gastroenterol. 1996;91:726–30.

    CAS  Google Scholar 

  16. Capristo E, Addolorato G, Greco AV, Gasbarrini G. Body composition and energy metabolism in celiac disease. Am J Gastroenterol. 1998;93:1596–7.

    Article  CAS  Google Scholar 

  17. Capristo E, Addolorato G, Mingrone G, De Gaetano A, Greco AV, Tataranni PA, et al. Changes in body composition, substrate oxidation, and resting metabolic rate in adult celiac disease patients after a 1-y gluten-free diet treatment. Am J Clin Nutr. 2000;72:76–81.

    CAS  Google Scholar 

  18. Capristo E, Malandrino N, Farnetti S, Mingrone G, Leggio L, Addolorato G, et al. Increased serum high-density lipoprotein-cholesterol concentration in celiac disease after gluten-free diet treatment correlates with body fat stores. J Clin Gastroenterol. 2009;43:946–9.

    Article  CAS  Google Scholar 

  19. Hallert C, Grant C, Grehn S, Grännö C, Hultén S, Midhagen G, et al. Evidence of poor vitamin status in celiac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther. 2002;16:1333–9.

    Article  CAS  Google Scholar 

  20. Smecuol E, Gonzalez D, Mautalen C, Siccardi A, Cataldi M, Niveloni S, Mazure R, Vazquez H, Pedreira S, Soifer G, Boerr LA, Mauriño E, Bai JC. Longitudinal study on the effect of treatment on body composition and anthropometry of celiac disease patients. Am J Gastroenterol. 1997;92:639–43.

    Google Scholar 

  21. Ukkola A, Mäki M, Kurppa K, Collin P, Huhtala H, Kekkonen L, et al. Changes in body mass index on a gluten-free diet in celiac disease: a nationwide study. Eur J Intern Med. 2012;23:384–8.

    Article  Google Scholar 

  22. Churruca I, Miranda J, Lasa A, Bustamante M, Larretxi I, Simon E. Analysis of body composition and food habits of Spanish celiac women. Forum Nutr. 2015;7:5515–31.

    Google Scholar 

  23. Bardella MT, Fredella C, Prampolini L, Molteni N, Giunta AM, Bianchi PA. Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. Am J Clin Nutr. 2000;72:937–9.

    CAS  Google Scholar 

  24. Martin J, Geisel T, Maresch C, Krieger K, Stein J. Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion. 2013;87:240–6.

    Article  CAS  Google Scholar 

  25. Pellegrini N, Agostoni C. Nutritional aspects of gluten-free products. J Sci Food Agric. 2015;95(12):2380–5.

    Article  CAS  Google Scholar 

  26. Houben A, Höchstötter A, Becker T. Possibilities to increase the quality in gluten-free bread production: an overview. Eur Food Res Technol. 2012;235:195–208.

    Article  CAS  Google Scholar 

  27. Marti A, Pagani MA. What can play the role of gluten in gluten-free pasta? Trends Food Sci Technol. 2013;31:63–71.

    Article  CAS  Google Scholar 

  28. Vici G, Belli L, Biondi M, Polzonetti V. Gluten-free diet and nutrient deficiencies: a review. Clin Nutr. 2016; doi:10.1016/j.clnu.2016.05.002.

    Google Scholar 

  29. Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV. Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Forum Nutr. 2013;5:4553–65.

    Google Scholar 

  30. Fasano A, Catassi C. Celiac disease in children. Best Pract Res Clin Gastroenterol. 2005;19:467–78.

    Article  Google Scholar 

  31. Telega G, Bennet TR, Werlin S. Emerging new clinical patterns in the presentation of celiac disease. Arch Pediatr Adolesc Med. 2008;162:164–8.

    Article  Google Scholar 

  32. Catassi C, Gatti S, Fasano A. The new epidemiology of celiac disease. J Pediatr Gastroenterol Nutr. 2014;59(Suppl 1):S7–9.

    Article  Google Scholar 

  33. Myléus A, Ivarsson A, Webb C, Danielsson L, Hernell O, Högberg L, et al. Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic. J Pediatr Gastroenterol Nutr. 2009;49(2):170–6.

    Article  Google Scholar 

  34. Mariani P, Viti MG, Montuori M, La Vecchia A, Cipolletta E, Calvani L, et al. The gluten-free diet: a nutritional risk factor for adolescents with celiac disease? J Pediatr Gastroenterol Nutr. 1998;27:519–23.

    Article  CAS  Google Scholar 

  35. Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F, Danchielli C. Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr. 2010;64:1371–2.

    Article  CAS  Google Scholar 

  36. Dell'Olio D, Palma L, Malorgio E, AnsaldiBalocco N. What do celiac children eat? Dietary analysis of a group of children with celiac disease on a diet. Minerva Gastroenterol Dietol. 1995;41:269–73.

    Google Scholar 

  37. Hopman EG, le Cessie S, von Blomberg BM, Mearin ML. Nutritional management of the gluten-free diet in young people with celiac disease in The Netherlands. J Pediatr Gastroenterol Nutr. 2006;43:102–8.

    Article  CAS  Google Scholar 

  38. Ohlund K, Olsson C, Hernell O, Ohlund I. Dietary shortcomings in children on a gluten-free diet. J Hum Nutr Diet. 2010;23:294–300.

    Article  CAS  Google Scholar 

  39. Ferrara P, Cicala M, Tiberi E, Spadaccio C, Marcella L, Gatto A, et al. High fat consumption in children with celiac disease. Acta Gastroenterol Belg. 2009;72:296–300.

    CAS  Google Scholar 

  40. Kautto E, Ivarsson A, Norström F, Högberg L, Carlsson A, Hörnell A. Nutrient intake in adolescent girls and boys diagnosed with celiac disease at an early age is mostly comparable to their non-celiac contemporaries. J Hum Nutr Diet. 2014;27:41–53.

    Article  CAS  Google Scholar 

  41. Zuccotti G, Fabiano V, Dilillo D, Picca M, Cravidi C, Brambilla P. Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products. J Hum Nutr Diet. 2013;26:436–44.

    Article  CAS  Google Scholar 

  42. Salazar J, Espín B, Rodríguez A, Argüelles F, García R, Rubio M, et al. Valoración nutricional de la dieta sin gluten. ¿Es la dieta sin gluten deficitaria en algún nutriente? An Pediatr. 2015;83:33–9.

    Google Scholar 

  43. Babio N, Alcázar M, Castillejo G, Recasens M, Martínez-Cerezo F, Gutiérrez-Pensado V, et al. Patients with coeliac disease reported highter consumption of added sugar and total fat than healthy individuals. J Pediatr Gastroenterol Nutr. 2017;64(1):63–9.

    Article  CAS  Google Scholar 

  44. Erdem T, Ferat Ç, Nurdan YA, Halime E, Muhammed Selçuk S, Hamza K, et al. Vitamin and mineral deficiency in children newly diagnosed with celiac disease. Turk J Med Sci. 2015;45:833–6.

    Article  Google Scholar 

  45. García-Manzanares A, Lucendo AJ. Nutritional and dietary aspects of celiac disease. Nutr Clin Pract. 2011;26:163–73.

    Article  Google Scholar 

  46. Hadithi M, Mulder CJ, Stam F, Azizi J, Crusius JB, Peña AS, et al. Effect of B vitamin supplementation on plasma homocysteine levels in celiac disease. World J Gastroenterol. 2009;15:955–60.

    Article  CAS  Google Scholar 

  47. Newnham ED, Shepherd SJ, Strauss BJ, Hosking P, Gibson PR. Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with celiac disease: a 5-year longitudinal study from diagnosis. J Gastroenterol Hepatol. 2016;31:342–9.

    Article  CAS  Google Scholar 

  48. Catassi C, Fabiani E, Iacono G, D'Agate C, Francavilla R, Biagi F, et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr. 2007;85:160–6.

    CAS  Google Scholar 

  49. Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with celiac disease. Aliment Pharmacol Ther. 2008;27:1044–52.

    Article  CAS  Google Scholar 

  50. La Vieille S, Dubois S, Hayward S, Koerner TB. Estimated levels of gluten incidentally present in a Canadian gluten-free diet. Forum Nutr. 2014;6:881–96.

    Google Scholar 

  51. Oliveira OMV, Zandonadi RP, Gandolfi L, de Almeida RC, Almeida LM, Pratesi R. Evaluation of the presence of gluten in beans served at self-service restaurants: a problem for celiac disease carriers. J Culinary Sci Tech. 2014;12:22–33.

    Article  Google Scholar 

  52. Hallert C, Tobiasson P, Walan A. Serum folate determinations in tracing adult coeliacs. Scand J Gastroenterol. 1981;16:263–7.

    Article  CAS  Google Scholar 

  53. Stene-Larsen G, Mosvold J, Ly B. Selective vitamin B12 malabsorption in adult celiac disease. Report on three cases with associated autoimmune diseases. Scand J Gastroenterol. 1988;23:1105–8.

    Article  CAS  Google Scholar 

  54. Kemppainen T, Uusitupa M, Janatuinen E, Jarvinen R, Julkunen R, Pikkarainen P. Intakes of nutrients and nutritional status in coeliac patients. Scand J Gastroenterol. 1995;30:575–9.

    Article  CAS  Google Scholar 

  55. Kemppainen TA, Kosma VM, Janatuinen EK, Julkunen RJ, Pikkarainen PH, Uusitupa MI. Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet—Association with the grade of mucosal villous atrophy. Am J Clin Nutr. 1998;67:482–7.

    CAS  Google Scholar 

  56. Alwitry A. Vitamin A deficiency in coeliac disease. Br J Ophthalmol. 2000;84:1079–80.

    Article  CAS  Google Scholar 

  57. Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol. 2001;96:745–50.

    Article  CAS  Google Scholar 

  58. Dickey W. Low serum vitamin B12 is common in coeliac disease and is not due to autoimmune gastritis. Eur J Gastroenterol Hepatol. 2002;14:425–7.

    Article  CAS  Google Scholar 

  59. Hozyasz KK, Chelchowska M, Laskowska-Klita T. Vitamin E levels in patients with celiac disease. Med Wieku Rozwoj. 2003;7:593–604.

    Google Scholar 

  60. Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007;82:996–1000.

    Article  Google Scholar 

  61. Dickey W, Ward M, Whittle CR, Kelly MT, Pentieva K, Horigan G, Patton S, McNulty H. Homocysteine and related B-vitamin status in coeliac disease: effects of gluten exclusion and histological recovery. Scand J Gastroenterol. 2008;43:682–8.

    Article  CAS  Google Scholar 

  62. Henri-Bhargava A, Melmed C, Glikstein R, Schipper HM. Neurologic impairment due to vitamin E and copper deficiencies in celiac disease. Neurology. 2008;71:860–1.

    Article  Google Scholar 

  63. Bergamaschi G, Markopoulos K, Albertini R, Di Sabatino A, Biagi F, Ciccocioppo R, Arbustini E, Corazza GR. Anemia of chronic disease and defective erythropoietin production in patients with celiac disease. Haematologica. 2008;93:1785–91.

    Article  CAS  Google Scholar 

  64. Lerner A, Shapira Y, Agmon-Levin N, Pacht A, Ben-Ami Shor D, Lopez H, Sanchez-Castanon M, Shoenfeld Y. The clinical significance of 25OH-vitamin D status in celiac disease. Clin Rev Allergy Immunol. 2013;42:322–30.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Itziar Churruca PhD .

Rights and permissions

Reprints and permissions

Copyright information

© 2017 The Author(s)

About this chapter

Cite this chapter

Churruca, I., Larretxi, I., Lasa, A. (2017). Gluten-Free Diet: Nutritional Status and Dietary Habits of Celiac Patients. In: Nutritional and Analytical Approaches of Gluten-Free Diet in Celiac Disease. SpringerBriefs in Food, Health, and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-319-53342-1_6

Download citation

Publish with us

Policies and ethics