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Advantages and Disadvantages of Gluten-Free Diet in Celiac Disease and Role of Oats and Pseudo-Cereals

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Dear Colleagues,

Celiac disease (CeD) is a systemic immune-mediated disease that develops in genetically susceptible individuals. To date, the only approved therapy of the disease is a lifelong, strict gluten-free diet (GFD). A GFD is essential for CD patients, and has many beneficial effects: symptoms alleviate in most patients, small bowel mucosa heals, antibody production stops, and nutritive status and bone mineral density improve. These advantages could not be achieved with other alternative, new therapies until now. The lifelong restrictive GFD also has some drawbacks. First, gluten-free products are not obviously healthy: they usually contain more calories, simple carbohydrates, unsaturated fats, and salt than their gluten-containing counterparts, but contain less fiber as well as macro- and micronutrients. In the long run, this unbalanced diet can lead to undesirable weight gain, disproportionate body composition or even metabolic syndrome. Insufficient fiber intake adversely affects the microbiota composition, which generates further negative consequences. GFD has an impact on quality of life as well, but data in the literature are controversial in this regard.

The planned Special Issue discusses the GFD in terms of advantages and disadvantages. Studies that deal with changing symptoms during the diet, levels of macro- and micronutrients, body mass index and body composition, bone metabolism, microbiome, and quality of life are welcomed. We also welcome materials related to the composition of a healthy GFD and to the role of oats and pseudo-cereals in the diet.

Dr. Judit Bajor
Guest Editor

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Keywords

celiac disease
gluten-free diet
body composition
oats
pseudo-cereals
microbiome
quality of life

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13 pages, 1289 KiB

Open AccessArticle

Body Mass Index during Gluten-Free Diet in Patients with Celiac Disease

by Zsófia Vereczkei, Tímea Dergez, Zsuzsanna Fodor, Zsolt Szakács and Judit Bajor

Nutrients 2023, 15(16), 3517; https://doi.org/10.3390/nu15163517 - 10 Aug 2023

Cited by 1 | Viewed by 1010

Abstract

The association of clinical variables with body mass index (BMI) and changes experienced during a gluten-free diet (GFD) in celiac disease (CD) is not well established. In this retrospective cohort study, we aimed to investigate factors aligned with baseline and a follow-up regarding BMI in CD cases diagnosed at the University of Pécs (Hungary). Data were collected regarding gender, age, clinical presentation, histology, serology, extraintestinal manifestations, and BMI upon diagnosis and during follow-up. To compare variables with baseline BMI and BMI changes in short-, intermediate-, and long-term periods, we applied univariate analyses. A total of 192 CD patients were included. Males had significantly higher mean BMI when compared with females at diagnosis (22.9 ± 4.1 vs. 21.4 ± 4.3 kg/m², p = 0.041) and during follow-up (p = 0.031, p = 0.029, and p = 0.033 for short-, intermediate-, and long-term follow-ups, respectively). Non-classical CD patients experienced higher mean BMI at diagnosis (22.9 ± 4.0 vs. 20.7 ± 4.4 kg/m², p < 0.001) and following long-term follow-up (24.5 ± 3.2 vs. 22.6 ± 3.4 kg/m², p = 0.039) than classical patients. In conclusion, although the mean BMI remained in the normal range, it increased significantly during follow-up, even at the short-term follow-up. This change was characteristic for non-classical cases and males on the long-term follow-ups. Full article

(This article belongs to the Special Issue Advantages and Disadvantages of Gluten-Free Diet in Celiac Disease and Role of Oats and Pseudo-Cereals)

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Is There a Time and a Place for the Gluten-Free Diet in Potential Celiac Disease?

by Roxana Nemteanu, Andreea Clim, Corina Elena Hincu, Liliana Gheorghe, Irina Ciortescu, Anca Trifan and Alina Plesa

Nutrients 2023, 15(18), 4064; https://doi.org/10.3390/nu15184064 - 20 Sep 2023

Cited by 1 | Viewed by 1106

Abstract

Potential celiac disease (PCD) is characterized by the absence of villous atrophy on duodenal biopsies (Marsh 0 or 1) despite positive celiac serology and HLA DQ2 or DQ8 heterodimers. Recent epidemiological studies report that PCD represents one fifth of the total CD diagnoses. Compared to patients with CD, the majority of adult patients with PCD show lower rates of nutrient deficiencies and extraintestinal symptoms at diagnosis. Recommending a gluten-free diet (GFD) to PCD patients depends on whether they have symptoms or not. A significant clinical improvement is reported by symptomatic patients, but for asymptomatic PCD, diet implementation is still a matter of debate. Some questions remain to be answered: does PCD serve as an intermediary phase leading to the progression of true CD? Is it reasonable to hypothesize that PCD and active CD represent different manifestations of the same condition? Is there a potential for both underdiagnosis and overdiagnosis of CD in those who may have the condition? Additional research is required to address these inquiries and ascertain the specific subset of people with potential progression to overt CD, as well as to determine the potential advantages of early implementation of a GFD for these individuals. The investigation of risk factors in CD warrants examination of variables such as the timing of diagnosis, the genetic profile, the extent of gluten exposure, and the composition of the microbiome. Full article

(This article belongs to the Special Issue Advantages and Disadvantages of Gluten-Free Diet in Celiac Disease and Role of Oats and Pseudo-Cereals)

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