EFFETTO DELLA DIETA PRIVA DI GLUTINE SU ADIPOSITA', PROFILO LIPIDICO E METABOLISMO GLUCIDICO IN BAMBINI AFFETTI DA MALATTIA CELIACA: STUDIO MULTICENTRICO CONDOTTO IN ITALIA E IN ISRAELE

EFFECT OF A GLUTEN FREE DIET ON ADIPOSITY, LIPID PROFILE AND GLUCIDIC METABOLISM IN A COHORT OF CELIAC CHILDREN: MULTICENTRIC STUDY COMPARING ITALY AND ISRAEL Introduction. The classic symptoms of failure to thrive and diarrhea nowadays are infrequently seen in celiac disease (CD). Many patients present with normal or elevated body mass index (BMI) at diagnosis. Cardiovascular disease (CVD) have their roots in childhood. The evidences of an association between CD, gluten free diet (GFD) and CVD risk factors in children are limited. Aims and methods. Our aims were to define the trend of BMI z-scores in pediatric CD adhering to a GFD and to clarify the relationship between CD, GFD and CVD risk factors. We prospectively enrolled 114 CD children on GFD in remission, from Italy and Israel. At enrollment anthropometric measurements, blood lipids and glucose levels were assessed and compared to values at the time of diagnosis. HOMA-IR was calculated as a measure for insulin resistance. Results. Italian and Israeli patients had comparable anthropometry and lipid profiles. Trends towards the increase in overweight (from 8,8% to 11,5%) and obesity (from 5,3% to 8,8%) were seen in the total population after GFD. Furthermore, there were significant (p=0,013) increase in the percentage of children with borderline (from 11,3% to 29,8%) and elevated blood cholesterol (from 4,2% to 7%). At enrollment fasting insulin and HOMA-IR were significantly higher in the Italian cohort and 4 children fulfilled criteria for insulin resistance. Three or more CVD risk factors (BMI, waist circumference, LDL cholesterol, triglycerides, blood pressure and insulin resistance) were found in 14% of CD patients. Conclusion. This is the first study to report a high prevalence of CVD risk factors as well as insulin resistance in CD children on GFD. This study concurs with reports showing increasing percentages of overweight and obesity in patients adhering to GFD. These findings highlight the importance of dietary counseling over time, targeting obesity and CVD risk factors, in addition to monitoring adherence to a GFD.