Published online Sep 14, 2013. doi: 10.3748/wjg.v19.i34.5658
Revised: May 8, 2013
Accepted: June 18, 2013
Published online: September 14, 2013
Processing time: 192 Days and 17.2 Hours
AIM: To describe the cardiovascular disease (CVD) risk factors in a population of children with celiac disease (CD) on a gluten-free diet (GFD).
METHODS: This cross-sectional multicenter study was performed at Schneider Children’s Medical Center of Israel (Petach Tiqva, Israel), and San Paolo Hospital (Milan, Italy). We enrolled 114 CD children in serologic remission, who were on a GFD for at least one year. At enrollment, anthropometric measurements, blood lipids and glucose were assessed, and compared to values at diagnosis. The homeostasis model assessment-estimated insulin resistance was calculated as a measure of insulin resistance.
RESULTS: Three or more concomitant CVD risk factors [body mass index, waist circumference, low density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and insulin resistance] were identified in 14% of CD subjects on a GFD. The most common CVD risk factors were high fasting triglycerides (34.8%), elevated blood pressure (29.4%), and high concentrations of calculated LDL cholesterol (24.1%). On a GFD, four children (3.5%) had insulin resistance. Fasting insulin and HOMA-IR were significantly higher in the Italian cohort compared to the Israeli cohort (P < 0.001). Children on a GFD had an increased prevalence of borderline LDL cholesterol (24%) when compared to values (10%) at diagnosis (P = 0.090). Trends towards increases in overweight (from 8.8% to 11.5%) and obesity (from 5.3% to 8.8%) were seen on a GFD.
CONCLUSION: This report of insulin resistance and CVD risk factors in celiac children highlights the importance of CVD screening, and the need for dietary counseling targeting CVD prevention.
Core tip: In our study we demonstrate a relatively high proportion of children with celiac disease (CD) adherent to a gluten-free diet (GFD) with one or more cardiovascular disease (CVD) risk factors. Furthermore, this is the first report of insulin resistance in celiac patients either in adults or children. These findings suggest that screening for CVD risk factors in celiac children both at diagnosis and during follow-up is important. Furthermore, dietary counseling over time, targeting obesity and CVD risk factors in addition to monitoring adherence to a GFD in children and adolescents diagnosed with CD, may be warranted.