Paediatric Patients with Coeliac Disease on a Gluten-Free Diet: Nutritional Adequacy and Macro- and Micronutrient Imbalances
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Purpose of Review
A strict, lifelong gluten-free diet is the cornerstone for management of coeliac disease. Elimination of gluten from the diet may be associated with nutritional imbalance; however, the completeness of this diet in energy and macro- and micronutrients in children is not well described. Understanding the nutritional adequacy of the gluten-free diet in children during this critical period of growth and development when dietary intake is strongly influential is important.
Children, regardless of whether they have eliminated gluten from their diet, have a tendency to consume excess fat and insufficient fibre, iron, vitamin D and calcium, compared to recommendations. In the context of a gluten-free diet, these imbalances may be worsened or have more significant consequences. Paediatric studies have demonstrated that intakes of folate, magnesium, zinc and selenium may decrease on a gluten-free diet.
Nutritional inadequacies may be risks of a gluten-free diet in a paediatric population. The potential implications of these inadequacies, both short and long term, remain unclear and warrant further investigation and clarification.
KeywordsCoeliac disease Gluten-free diet Children Nutrition Macronutrient Micronutrient
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Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 5.Hill ID, Bhatnagar S, Cameron DJ, De Rosa S, Maki M, Russell GJ, et al. Celiac disease: working group report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2002;35:S78–88. https://doi.org/10.1097/00005176-200208002-00004.CrossRefPubMedGoogle Scholar
- 7.DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scand J Gastroenterol. 2013;48(8):921–5. https://doi.org/10.3109/00365521.2013.809598.CrossRefPubMedGoogle Scholar
- 17.Kautto E, Rydén P, Ivarsson A, Olsson C, Norström F, Högberg L, et al. What happens to food choices when a gluten-free diet is required? A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers. J Nutr Sci. 2014;3 https://doi.org/10.1017/jns.2013.24.
- 19.Ferrara P, Cicala M, Tiberi E, Spadaccio C, Marcella L, Gatto A, et al. High fat consumption in children with celiac disease. Acta Gastro-Enterol Belg. 2009;72(3):296–300.Google Scholar
- 20.•• Kautto E, Ivarsson A, Norstrom F, Hogberg L, Carlsson A, Hornell A. Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries. J Hum Nutr Diet. 2014;27(1):41–53. Relatively recently published case-control study on children with coeliac disease with well-documented methodology and has conducted subanalysis by gender.CrossRefPubMedGoogle Scholar
- 21.• Balamtekin N, Aksoy C, Baysoy G, Uslu N, Demir H, Koksal G, et al. Is compliance with gluten-free diet sufficient? Diet composition of celiac patients. Turkish J Pediatr. 2015;57(4):374–9. Recently published case-control study that has compared children with coeliac disease on long-term gluten-free diets (at least 1 year) to controls.Google Scholar
- 22.•• Babio N, Alcázar M, Castillejo G, Recasens M, Martínez-Cerezo F, Gutiérrez-Pensado V, et al. Patients with celiac disease reported higher consumption of added sugar and total fat than healthy individuals. J Pediatr Gastroenterol Nutr. 2017, 64;(1):63–9. Largest and most recently published case-control study conducted in children with coeliac disease and the only study to match cases and controls by age, gender and BMI.Google Scholar
- 25.Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, et al. Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr. 2014;68(6):700–6. https://doi.org/10.1038/ejcn.2013.286.CrossRefPubMedGoogle Scholar
- 31.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(1):102–8. https://doi.org/10.1097/01.mpg.0000228102.89454.eb.CrossRefPubMedGoogle Scholar
- 34.Tokudome Y, Imaeda N, Nagaya T, Ikeda M, Fujiwara N, Sato J, et al. Daily, weekly, seasonal, within-and between-individual variation in nutrient intake according to four season consecutive 7 day weighed diet records in Japanese female dietitians. J Epidemiol. 2002;12(2):85–92. https://doi.org/10.2188/jea.12.85.CrossRefPubMedGoogle Scholar
- 41.Forchielli ML, Fernicola P, Diani L, Scrivo B, Salfi NC, Pessina AC, et al. Gluten-free diet and lipid profile in children with celiac disease: comparison with general population standards. J Pediatr Gastroenterol Nutr. 2015;61(2):224–9. https://doi.org/10.1097/MPG.0000000000000785.CrossRefPubMedGoogle Scholar
- 42.Jastrebova J, Jägerstad M. Novel fortification strategies for staple gluten-free products. In: Preedy VR, Srirajaskanthan R, Patel VB, editors. Handbook of food fortification and health: from concepts to public health applications volume 1. New York: Springer New York; 2013. p. 307–20. https://doi.org/10.1007/978-1-4614-7076-2_24.CrossRefGoogle Scholar
- 43.Ma Y, Peng D, Liu C, Huang C, Luo J. Serum high concentrations of homocysteine and low levels of folic acid and vitamin B 12 are significantly correlated with the categories of coronary artery diseases. BMC Cardiovasc Disord. 2017;17(1):37. https://doi.org/10.1186/s12872-017-0475-8.CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Blazina Š, Bratanič N, Čampa AŠ, Blagus R, Orel, R. Bone mineral density and importance of strict gluten-free diet in children and adolescents with celiac disease. Bone. 2010;47(3):598–603. https://doi.org/10.1016/j.bone.2010.06.008.