Assessment of Nutritional Status by Bioelectrical Impedance in Adult Patients with Celiac Disease: A Prospective Single-Center Study

The gluten-free diet [GFD] has been linked to an increased risk of weight gain and the development of metabolic disorders. Most of the studies have focused on the effect of GFD on the Body Mass Index [BMI]. We aimed to evaluate the nutritional status using specific nutritional parameters in patients with celiac disease [CeD] at diagnosis and on a GFD compared to healthy controls. We recruited subjects at our outpatient clinic at the University of Padua. We collected demographic and clinical data and values obtained with bioelectrical impedance analysis. A total of 24 CeD patients and 28 healthy controls were enrolled. CeD patients at diagnosis had a lower body cell mass index [BCMI, p = 0.006], fat-free mass index [FFMI, p = 0.02], appendicular skeletal muscle index [ASMI, p = 0.02], and phase angle [PA] [p < 0.001] compared to controls. Their percentage of extracellular water [ECW] was also higher [p < 0.001]. Considering CeD patients after GFD, nutritional status significantly improved after 6 months of GFD. We did not observe differences in BMI among groups [p = ns]. CeD patients at diagnosis were found to have a poorer nutritional status than healthy controls, with a positive effect of the GFD on their nutritional status, underlining the inefficacy of evaluating this aspect through only BMI evaluation.

[1]  M. Matsuhisa,et al.  Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes. , 2023, Heliyon.

[2]  Yanjun Liu,et al.  Reference Data of Phase Angle Using Bioelectrical Impedance Analysis in Overweight and Obese Chinese , 2022, Frontiers in Endocrinology.

[3]  L. Elli,et al.  Guidelines of the Italian societies of gastroenterology on the diagnosis and management of coeliac disease and dermatitis herpetiformis. , 2022, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[4]  M. Kostecka,et al.  An Evaluation of Nutritional Status and Problems with Dietary Compliance in Polish Patients with Celiac Disease , 2022, Nutrients.

[5]  G. Alshammari,et al.  Long-Term Effect of Gluten-Free Diets on Nutritional Status, Body Composition, and Associated Factors in Adult Saudi Females with Celiac Disease , 2022, Nutrients.

[6]  N. Katsura,et al.  Extracellular water to total body water ratio may mediate the association between phase angle and mortality in patients with cancer cachexia: A single-center, retrospective study. , 2021, Clinical Nutrition ESPEN.

[7]  P. Hegyi,et al.  It Is High Time for Personalized Dietary Counseling in Celiac Disease: A Systematic Review and Meta-Analysis on Body Composition , 2021, Nutrients.

[8]  G. Varela-Moreiras,et al.  Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac , 2021, Nutrients.

[9]  M. Ekramzadeh,et al.  Evaluation of malnutrition status and clinical indications in children with celiac disease: a cross-sectional study , 2021, BMC Pediatrics.

[10]  E. Nakano,et al.  Glycemic Index of Gluten-Free Bread and Their Main Ingredients: A Systematic Review and Meta-Analysis , 2021, Foods.

[11]  A. Alisi,et al.  Metabolic‐associated fatty liver disease (MAFLD) in coeliac disease , 2020, Liver international : official journal of the International Association for the Study of the Liver.

[12]  L. Scalfi,et al.  Bioelectrical impedance analysis (BIA) -derived phase angle in sarcopenia: A systematic review. , 2020, Clinical nutrition.

[13]  S. Jiménez Treviño,et al.  Influence of nutrition education in paediatric coeliac disease: impact of the role of the registered dietitian: a prospective, single-arm intervention study. , 2020, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[14]  S. Baker,et al.  Celiac Disease Nutritional Status and Poor Adherence to Follow-up , 2020, Clinical pediatrics.

[15]  D. Sanders,et al.  European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders , 2019, United European gastroenterology journal.

[16]  S. Necozione,et al.  Metabolic Alterations in Celiac Disease Occurring after Following a Gluten-Free Diet , 2018, Digestion.

[17]  P. H. Green,et al.  Global Prevalence of Celiac Disease: Systematic Review and Meta‐analysis , 2018, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[18]  D. Seidner,et al.  Nutritional Consideration in Celiac Disease and Nonceliac Gluten Sensitivity. , 2017, Gastroenterology clinics of North America.

[19]  H. Lukaski,et al.  Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio , 2017, Current opinion in clinical nutrition and metabolic care.

[20]  M. Camilleri,et al.  Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study. , 2017, Gastroenterology.

[21]  C. Mulder,et al.  Outcome of Referrals for Non-Responsive Celiac Disease in a Tertiary Center: Low Incidence of Refractory Celiac Disease in the Netherlands , 2017, Clinical and Translational Gastroenterology.

[22]  V. Polzonetti,et al.  Gluten free diet and nutrient deficiencies: A review. , 2016, Clinical nutrition.

[23]  Peta,et al.  Nutritional profile of adult patients with celiac disease. , 2015, European review for medical and pharmacological sciences.

[24]  S. Murch,et al.  Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance , 2015, BMJ : British Medical Journal.

[25]  G. Kahaly,et al.  Bioimpedance phase angle indicates catabolism in Type 2 diabetes , 2015, Diabetic medicine : a journal of the British Diabetic Association.

[26]  M. Bustamante,et al.  Analysis of Body Composition and Food Habits of Spanish Celiac Women , 2015, Nutrients.

[27]  J. Bai,et al.  Advances in diagnosis and management of celiac disease. , 2015, Gastroenterology.

[28]  N. Caporaso,et al.  Metabolic syndrome in patients with coeliac disease on a gluten‐free diet , 2015, Alimentary pharmacology & therapeutics.

[29]  O. Kwon,et al.  Use of Bioelectrical Impedance Analysis for the Assessment of Nutritional Status in Critically Ill Patients , 2015, Clinical nutrition research.

[30]  D. Balduzzi,et al.  A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life. , 2012, The British journal of nutrition.

[31]  A. Rubio‐Tapia,et al.  The Prevalence of Celiac Disease in the United States , 2012, The American Journal of Gastroenterology.

[32]  K. Kaukinen,et al.  Changes in body mass index on a gluten-free diet in coeliac disease: a nationwide study. , 2012, European journal of internal medicine.

[33]  D. Sanders,et al.  The Oslo definitions for coeliac disease and related terms , 2012, Gut.

[34]  Duncan J Macfarlane,et al.  Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review , 2011, The international journal of behavioral nutrition and physical activity.

[35]  A. Lucendo,et al.  Resolution of metabolic syndrome after following a gluten free diet in an adult woman diagnosed with celiac disease. , 2011, World journal of gastrointestinal pathophysiology.

[36]  E. Valletta,et al.  Celiac disease and obesity: need for nutritional follow-up after diagnosis , 2010, European Journal of Clinical Nutrition.

[37]  P. Howdle,et al.  Evidence of high sugar intake, and low fibre and mineral intake, in the gluten‐free diet , 2010, Alimentary pharmacology & therapeutics.

[38]  A. Gasbarrini,et al.  Celiac Disease in the 21st Century: Issues of Under-and Over-Diagnosis , 2009, International journal of immunopathology and pharmacology.

[39]  W. Dickey,et al.  Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet , 2006, The American Journal of Gastroenterology.

[40]  G. Corazza,et al.  Coeliac disease , 2005, Journal of Clinical Pathology.

[41]  M. Elia,et al.  Bioelectrical impedance analysis-part II: utilization in clinical practice. , 2004, Clinical nutrition.

[42]  J. Murray,et al.  Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. , 2004, The American journal of clinical nutrition.

[43]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[44]  G. Oberhuber,et al.  The histopathology of coeliac disease: time for a standardized report scheme for pathologists. , 1999, European journal of gastroenterology & hepatology.

[45]  G. Corazza,et al.  Differences in metabolic variables between adult coeliac patients at diagnosis and patients on a gluten-free diet. , 1997, Scandinavian journal of gastroenterology.

[46]  G. Castillejo,et al.  Patients With Celiac Disease Reported Higher Consumption of Added Sugar and Total Fat Than Healthy Individuals , 2017, Journal of pediatric gastroenterology and nutrition.

[47]  M. Barone,et al.  A comparison of the nutritional status between adult celiac patients on a long-term, strictly gluten-free diet and healthy subjects , 2016, European Journal of Clinical Nutrition.

[48]  C. Castillo-Durán,et al.  [Micronutrient deficiencies and celiac disease in Pediatrics]. , 2014, Archivos argentinos de pediatria.

[49]  D. Lam-Himlin European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease , 2013 .

[50]  Who Consultation on Obesity Obesity: preventing and managing the global epidemic. Report of a WHO consultation. , 2000, World Health Organization technical report series.

[51]  Steven B. Heymsfield,et al.  Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement. , 1996, The American journal of clinical nutrition.