Auteur Topic: Functional and Metabolic Disorders in Celiac Disease: New Implication  (gelezen 11480 keer)


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J Med Food 17 (11) 2014, 16
# Mary Ann Liebert, Inc., and Korean Society of Food Science and Nutrition
DOI: 10.1089/jmf.2014.0025

Functional and Metabolic Disorders in Celiac Disease:
New Implications for Nutritional Treatment

Sara Farnetti, Maria Assunta Zocco, Matteo Garcovich, Antonio Gasbarrini, and Esmeralda Capristo
Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.

Celiac disease (CD) is a chronic disease causing the inflammation of the proximal small intestine, in genetically predisposed individuals.
This is triggered by the consumption of the gluten protein and the side effects of the disease are mitigated by a lifelong gluten-free diet (GFD) treatment.
The predominant consequence of CD is malnutrition due to malabsorption (with diarrhea, weight loss, nutritional deficiencies, and altered blood parameters), especially in patients who do not show strict adherence to GFD treatment.

Recent evidence shows that, despite a lifelong GFD, some functional disorders persist, such as compromised gallbladder function and motility, exocrine pancreatic insufficiency, increased gut permeability, small-intestinal bowel overgrowth, nonalcoholic fatty liver disease (NAFLD), lactose intolerance, and milk allergy.
These abnormalities may predispose to the occurrence of overweight and obesity even in CD patients.

This review focuses on the principal functional and metabolic disorders in both treated and untreated CD, ranging from alterations of the gastrointestinal system to impaired glucose and lipid metabolism and insulin secretion with the aim of providing new implications beyond a GFD, for an ad hoc nutrition treatment in these patients.

Celiac disease (CD) is a chronic immune-mediated,
gluten-dependent enteropathy induced by the ingestion
of gluten-containing products, characterized by intestinal
malabsorption and subtotal or total atrophy of the intestinal
CD treatment consists of  etc.

A systematic literature review was conducted to identify
published data relating to CD and a lifelong treatment with a
GFD using the MEDLINE, EMBASE, and Web of Science
databases until December 2013. Search terms included  etc.

Functional disorder in CD and its nutritional treatment
Several studies demonstrate a prevalence from 28% to
40% of functional gastrointestinal (GI) disorders, such as
erosive reflux disease,6,7 abdominal pain, and swelling, in
patients with CD.

Compromised gallbladder function and motility.
In celiac subjects with significant villous atrophy, but also with
intraepithelial lymphocyte infiltration and little villous atrophy,
8 enteric hormone secretion   etc.

Small-intestinal bacterial overgrowth, nonalcoholic fatty liver disease, increased gut permeability, and exocrine pancreatic insufficiency.
Intestinal ecoflora  etc.

Lactose intolerance and milk allergy.
Another cause of persistence of GI symptoms can be lactose intolerance, which represents a common finding in 70% of   etc.

Lipid metabolism in CD
As far as lipid profile in CD patients is concerned, an
alteration in lipid metabolism can easily occur in disorders
of the small-bowel mucosa etc.

CD and obesity
Recent and unexpected evidence showed an increased
prevalence of obesity among subjects affected by subclinical
or silent CD, in both childhood and adolescence.26 Almost
half of adult patients with CD were found to have a
body mass index (BMI) over 25 kg/m2 at diagnosis, thus
identifying a condition of overweightness, and retrospective
data on children with CD showed that 5% of patients had
BMI > 95th percentile.27
The most common presenting symptoms among obese  etc.

Gluten-free products and glycemic load

Nutritional deficiencies and the role of gastric acid status
* Vitamin D and calcium  etc.
* Folic acid. etc.
* Vitamin B12. etc.
* Iron. etc.
* Nickel  etc.

Table 1. Comprehensive Nutritional Advice in Celiac Disease
 Consume natural gluten-free foods, rich in fibers and with low glycemic load
 Avoid products with hydrogenated and trans fats
 Monitor total meal and daily nickel load
 Recommend and guide to use of high-calcium-content food instead of milk and  derivatives  in presence of milk intolerance and allergy
 Check diet folic acid and iron content
 Suggest to addition of ascorbic acid and citric acid to enhance vitamin and mineral
 Inadequate nutritional status may be related to an impaired gastric acid status.
 Evaluate the correct indications for PPI use in CD patients with vitamin B12, folic acid, 
 iron, and calcium malabsorption
 Recommend to consume cholagogue and choleretic food and cooking methods to improve
 gallbladder function and motility and fatsoluble vitamin absorption
 Reduce foods and GF products containing phytic acid to improve the bioavailability of
 nutrients and substances as iron, calcium, manganese, and zinc

A correct dietary treatment of CD patients may largely
improve nutritional status and decrease malnutrition-related
complication in the long term, improving quality of life and
reducing mortality. Further, new evidences suggest that
adherence to a lifelong GFD may not represent the only
factor that has to be taken into account in the nutritional
treatment of CD patients, but also a variety of functional and
metabolic alterations should play a role in the occurrence
and maintenance of nutritional deficiencies, as those summarized
in this review and reported in Table 1.

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