Study Name: Metabolic Syndrome in Patients With Coeliac Disease on a Gluten-free Diet
Authors: R. Tortora*, P. Capone*, G. De Stefano*, N. Imperatore*, N. Gerbino*, S. Donetto†, V. Monaco*, N. Caporaso* & A. Rispo*
*Gastroenterology – Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.Results: Ninety-eight patients with CD were assessed, two patients with CD (2%) fulfilled the diagnostic criteria for metabolic syndrome at diagnosis and 29 patients (29.5%) after 12 months of GFD (P < 0.01; OR: 20). With regard to metabolic syndrome sub-categories 1 year after GFD compared to baseline respectively: 72 vs. 48 patients exceeded waist circumference cut-off (P < 0.01; OR: 2.8); 18 vs. 4 patients had high blood pressure (P < 0.01; OR: 5.2); 25 vs. 7 patients exceeded glycemic threshold (P= 0.01; OR: 4.4); 34 vs. 32 patients with CD had reduced levels of HDL cholesterol (P = 0.7); and 16 vs. 7 patients had high levels of triglycerides (P = 0.05).
Conclusions: Patients with coeliac disease show a high risk of metabolic syndrome 1 year after starting a gluten-free diet. We suggest that an in-depth nutritional assessment is undertaken for all patients with coeliac disease.
“Our results suggest that the majority of newly diagnosed patients with CD who are normal or overweight at baseline are likely to become overweight or obese after the introduction of GFD, with the potential development of MS and/or HS. The increase in weight could be a consequence of the improvement in intestinal absorption (caused by the exclusion of gluten from the diet) in subjects who are in a compensative hyperphagic status. However, it remains to be established whether the GFD itself contributes to the development of overweight/obesity in patients with CD. Several studies have confirmed that long-term GFD may not be nutritionally balanced. Indeed, there is clinical evidence indicating high intake of simple sugars, proteins and saturated fat and intake of complex carbohydrates and fibre in such diets.[28–30] In addition, increased total caloric intake, the macronutrient composition of the diet, may be involved in the pathogenesis of overweight and obesity in patients with CD. Many gluten-free foods are characterised by a glycemic index which is higher than that of equivalent gluten-containing foods,[31,32] although this is refuted by some authors.[33] The higher glycemic index of gluten-free foods could be partially explained by the fact that in ‘normal’ conditions gluten does not allow the amylase to easily access and hydrolyse starch granules in the lumen of the small intestine, thus reducing starch adsorption. Also, the unpalatability of some gluten-free foods may induce a preference towards hyperproteic and hyperlipidemic foods,[28,34] which, in turn, may lead to increased energy intake and subsequent weight gain.
Among the other MS criteria showing significant changes, blood pressure was the most important: our results highlight that patients with CD on GFD show a 4-fold increase in their risk of developing systemic hypertension.”
To ready entire Study Abstract on Medscape.com open HERE
MS: Metabolic Syndrome
HS: Hepatic Steatosis
