Digestive Diseases and Sciences

, Volume 62, Issue 9, pp 2440–2448 | Cite as

Obesity, Metabolic Syndrome, and Cardiovascular Risk in Gluten-Free Followers Without Celiac Disease in the United States: Results from the National Health and Nutrition Examination Survey 2009–2014

  • Hyun-seok Kim
  • Michael F. Demyen
  • Justin Mathew
  • Neil Kothari
  • Mirela Feurdean
  • Sushil K. Ahlawat
Original Article
First Online:
Received:
Accepted:

Abstract

Background

Despite unclear benefits of gluten-free diets (GFD) in the general population, gluten-free followers without medical indications are driving the market. Few studies have investigated health benefits of GFD in the general population.

Aims

To estimate metabolic and cardiovascular disease (CVD) risk profiles among gluten-free followers without celiac disease (CD).

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009–2014. There were 13,523 persons without CD who had GFD information. People with known CVD were excluded. We compared gluten-free followers without CD and the general population by selective metabolic and CVD risk profiles using survey-weighted generalized logistic regression.

Results

There were 155 gluten-free followers without CD and CVD, corresponding to a weighted prevalence of 1.3% (3.2 million Americans). Gluten-free followers tended to be women and have a smaller waist circumference and higher HDL cholesterol. They also had a lower BMI with a borderline p value (0.053) and significant self-reported weight loss (−1.33 kg) over one year. Moreover, gluten-free followers were more likely to consider their weight appropriate. There was no statistical difference by age, smoking, hypertension, total cholesterol, triglyceride cholesterol, HbA1c, or fasting glucose. Despite a lower probability of having metabolic syndrome (33.0 vs 38.5%) and lower 10-year CVD risk score (4.52 vs 5.70%) in gluten-free followers, there was no statistical difference.

Conclusions

Although being on a GFD may be beneficial in weight management, there was no significant difference in terms of prevalence of metabolic syndrome and CVD risk score in gluten-free followers without CD.

Keywords

Gluten-free diet Obesity Metabolic syndrome Cardiovascular risk 
This is a preview of subscription content, log in to check access.

Notes

Author's contributions

HSK and SKA are involved in study and design. All authors are involved in acquisition, analysis, or interpretation of data. All authors are involved in drafting of the manuscript. All authors are involved in critical revision of the manuscript for important intellectual content. HSK is involved in statistical analysis. All authors are involved in administrative, technical, or material support. HSK, MFD, NK, MF, SKA are involved in study supervision. Dr. H.S. Kim had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    MarketsandMarkets. Gluten-Free Products Market by Type (Bakery Products, Pizzas & Pastas, Cereals & Snacks, Savories, and Others), Source (Oilseeds & Pulses, Rice & Corn, Dairy & Meat Products, and Other Crops), & by Region—Global Trends & Forecast to 2020. (http://www.marketsandmarkets.com/Market-Reports/gluten-free-products-market-738.html).
  2. 2.
    Topper A. Non-celiacs drive gluten-free market growth. Mintel. 2014; http://www.mintel.com/blog/food-market-news/gluten-free-consumption-trends.
  3. 3.
    Kim HS, Patel KG, Orosz E, et al. Time trends in the prevalence of celiac disease and gluten-free diet in the us population: results from the National Health and Nutrition Examination Surveys 2009–2014. JAMA Intern Med. 2016;176:1716–1717.CrossRefPubMedGoogle Scholar
  4. 4.
    Gaesser G, Angadi S. Navigating the gluten-free boom. J Am Acad Phys Assist. 2015;28:1–7.Google Scholar
  5. 5.
    Marcason W. Is there evidence to support the claim that a gluten-free diet should be used for weight loss? J Am Diet Assoc. 2011;111:1786.CrossRefPubMedGoogle Scholar
  6. 6.
    Holmes GK, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease–effect of a gluten free diet. Gut. 1989;30:333–338.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999;117:297–303.CrossRefPubMedGoogle Scholar
  8. 8.
    Cosnes J, Cellier C, Viola S, et al. Incidence of autoimmune diseases in celiac disease: protective effect of the gluten-free diet. Clin Gastroenterol Hepatol. 2008;6:753–758.CrossRefPubMedGoogle Scholar
  9. 9.
    Kurppa K, Paavola A, Collin P, et al. Benefits of a gluten-free diet for asymptomatic patients with serologic markers of celiac disease. Gastroenterology. 2014;147:610–617 e611.Google Scholar
  10. 10.
    Sabatino A, Corazza G. Nonceliac gluten sensitivity: sense or sensibility? Ann Intern Med. 2012;156:309–311.CrossRefPubMedGoogle Scholar
  11. 11.
    Fasano A, Sapone A, Zevallos V, Schuppan D. Nonceliac gluten sensitivity. Gastroenterology. 2015;148:1195–1204.CrossRefPubMedGoogle Scholar
  12. 12.
    Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106:508–514.CrossRefPubMedGoogle Scholar
  13. 13.
    Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013;23:292–299.CrossRefPubMedGoogle Scholar
  14. 14.
    Rizzo NS, Sabate J, Jaceldo-Siegl K, Fraser GE. Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the adventist health study 2. Diabetes Care. 2011;34:1225–1227.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fraser G, Katuli S, Anousheh R, Knutsen S, Herring P, Fan J. Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study-2. Public Health Nutr. 2015;18:537–545.CrossRefPubMedGoogle Scholar
  16. 16.
    Kastorini CM, Panagiotakos DB, Chrysohoou C, et al. Metabolic syndrome, adherence to the Mediterranean diet and 10-year cardiovascular disease incidence: The ATTICA study. Atherosclerosis. 2016;246:87–93.CrossRefPubMedGoogle Scholar
  17. 17.
    NCHS. 2013–2014 Data Documentation, Codebook, and Frequencies: Medical Conditions (MCQ_H). (https://wwwn.cdc.gov/Nchs/Nhanes/2013-2014/MCQ_H.htm).
  18. 18.
    Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107:1538–1544; quiz 1537, 1545.Google Scholar
  19. 19.
    Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1–452.Google Scholar
  20. 20.
    Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752.CrossRefPubMedGoogle Scholar
  21. 21.
    NHLBI. Assessing cardiovascular risk: systemic evidence review from the risk assessment work group. 2013 (https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/risk-assessment.pdf).
  22. 22.
    NCHS. 2009–2010 Data Documentation, Codebook, and Frequencies: Weight History (WHQ_F). https://wwwn.cdc.gov/Nchs/Nhanes/2009-2010/WHQ_F.htm-WHQ030.
  23. 23.
    Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9:1–19.CrossRefGoogle Scholar
  24. 24.
    Breslow NE, Day NE. Statistical methods in cancer research. Volume II–The design and analysis of cohort studies. IARC Sci Publ. 1987;82:1–406.Google Scholar
  25. 25.
    Lee AR, Ng DL, Zivin J, Green PHR. Economic burden of a gluten-free diet. J Hum Nutr Diet. 2007;20:423–430.CrossRefPubMedGoogle Scholar
  26. 26.
    Stevens L, Rashid M. Gluten-free and regular foods: a cost comparison. Can J Diet Pract Res. 2008;69:147–150.CrossRefPubMedGoogle Scholar
  27. 27.
    Singh J, Whelan K. Limited availability and higher cost of gluten-free foods. J Hum Nutr Diet. 2011;24:479–486.CrossRefPubMedGoogle Scholar
  28. 28.
    Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006;101:2356–2359.CrossRefPubMedGoogle Scholar
  29. 29.
    Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004;79:669–673.PubMedGoogle Scholar
  30. 30.
    Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010;44:267–271.CrossRefPubMedGoogle Scholar
  31. 31.
    Kabbani TA, Goldberg A, Kelly CP, et al. Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Alim Pharmacol Ther. 2012;35:723–729.CrossRefGoogle Scholar
  32. 32.
    Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Publ Health. 1992;82:816–820.CrossRefGoogle Scholar
  33. 33.
    Adler NE, Ostrove JM. Socioeconomic status and health: what we know and what we don’t. Ann N Y Acad Sci. 1999;896:3–15.CrossRefPubMedGoogle Scholar
  34. 34.
    Capristo E, Malandrino N, Farnetti S, 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;43:946–949.CrossRefPubMedGoogle Scholar
  35. 35.
    Brar P, Kwon GY, Holleran S, et al. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med. 2006;119:786–790.CrossRefPubMedGoogle Scholar
  36. 36.
    Lewis NR, Sanders DS, Logan RF, Fleming KM, Hubbard RB, West J. Cholesterol profile in people with newly diagnosed coeliac disease: a comparison with the general population and changes following treatment. Br J Nutr. 2009;102:509–513.CrossRefPubMedGoogle Scholar
  37. 37.
    Wild D, Robins GG, Burley VJ, Howdle PD. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Alimen Pharmacol Therapeut. 2010;32:573–581.CrossRefGoogle Scholar
  38. 38.
    Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet. 2005;18:163–169.CrossRefPubMedGoogle Scholar
  39. 39.
    Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet. 2005;18:163–169.CrossRefPubMedGoogle Scholar
  40. 40.
    Wild D, Robins GG, Burley VJ, Howdle PD. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Aliment Pharmacol Ther. 2010;32:573–581.CrossRefPubMedGoogle Scholar
  41. 41.
    De Palma G, Nadal I, Collado M, Sanz Y. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr. 2009;102:1154–1160.CrossRefPubMedGoogle Scholar
  42. 42.
    Round J, Mazmanian S. The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol. 2009;9:313–323.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Yeboah J, Young R, McClelland RL, et al. Utility of nontraditional risk markers in atherosclerotic cardiovascular disease risk assessment. J Am Coll Cardiol. 2016;67:139–147.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Sibley C, Blumenthal RS, Merz CN, Mosca L. Limitations of current cardiovascular disease risk assessment strategies in women. J Womens Health (Larchmt). 2006;15:54–56.CrossRefGoogle Scholar
  45. 45.
    Lee GK, Lee LC, Liu CW, et al. Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction. Ann Acad Med Singapore. 2010;39:163–167.PubMedGoogle Scholar
  46. 46.
    Gluten: going against the grain?. Lancet Gastroenterol Hepatol 2016;1:85.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Hyun-seok Kim
    • 1
  • Michael F. Demyen
    • 1
    • 2
  • Justin Mathew
    • 1
  • Neil Kothari
    • 1
  • Mirela Feurdean
    • 1
  • Sushil K. Ahlawat
    • 1
    • 2
  1. 1.Department of MedicineRutgers New Jersey Medical SchoolNewarkUSA
  2. 2.Division of Gastroenterology and HepatologyRutgers New Jersey Medical SchoolNewarkUSA

Personalised recommendations