Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

Lorcan McGrogan; Mary Mackinder; Fiona Stefanowicz; Maria Aroutiounova; Anthony Catchpole; John Wadsworth; Elaine Buchanan; Tracey Cardigan; Hazel Duncan; Richard Hansen; Richard K. Russell; Christine A. Edwards; Dinesh Talwar; Paraic McGrogan; Konstantinos Gerasimidis

doi:10.1016/j.clnu.2021.03.006

Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

Lorcan McGrogan, Mary Mackinder, Fiona Stefanowicz, Maria Aroutiounova, Anthony Catchpole, John Wadsworth, Elaine Buchanan, Tracey Cardigan, Hazel Duncan, Richard Hansen, Richard K. Russell, Christine A. Edwards, Dinesh Talwar, Paraic McGrogan, Konstantinos Gerasimidis

Research output: Contribution to journal › Article › peer-review

21 Citations (Web of Science)

Abstract

Introduction: In coeliac disease (CD) micronutrient deficiencies may occur due to malabsorption in active disease and diminished intake during treatment with a gluten-free diet (GFD). This study assessed the micronutrient status in children with CD at diagnosis and follow-up.

Methods: Fifteen micronutrients were analysed in 106 blood samples from newly diagnosed CD and from patients on a GFD for <6 months, 6-12 months and with longstanding disease (> 12 months). Predictors of micronutrient status included: demographics, disease duration, anthropometry, gastrointestinal symptoms, raised tissue transglutaminase antibodies (TGA), multivitamin use and faecal gluten immunogenic peptide (GIP). Micronutrient levels were compared against laboratory reference values.

Results: At CD diagnosis (n = 25), low levels in > 10% of patients were observed for: vitamins E (88%), B1 (71%), D (24%), K (21%), A (20%) and B6 (12%), ferritin (79%), and zinc (33%). One year post-diagnosis, repletion of vitamins E, K, B6 and B1 was observed (<10% patients). In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis. Copper, selenium and magnesium did not differ significantly between diagnosis and follow-up. All samples for B2, folate, vitamin C (except for one sample) and B12 were normal. A raised TGA at follow-up was associated with low vitamins A and B1 (raised vs normal TGA; vitamin A: 40% vs 17%, p = 0.044, vitamin B1: 37% vs 13%, p = 0.028). Low vitamin A (p = 0.009) and vitamin D (p = 0.001) were more common in samples collected during winter. There were no associations between micronutrient status with GIP, body mass index, height, socioeconomic status, or gastrointestinal symptom. Multivitamin use was less common in patients with low vitamin D. Conclusions: Several micronutrient deficiencies in CD respond to a GFD but others need to be monitored long-term and supplemented where indicated.

Original language	English
Pages (from-to)	2784-2790
Number of pages	7
Journal	Clinical Nutrition
Volume	40
Issue number	5
DOIs	https://doi.org/10.1016/j.clnu.2021.03.006
Publication status	Published - May 2021
Externally published	Yes

Access to Document

10.1016/j.clnu.2021.03.006

Cite this

McGrogan, L., Mackinder, M., Stefanowicz, F., Aroutiounova, M., Catchpole, A., Wadsworth, J., Buchanan, E., Cardigan, T., Duncan, H., Hansen, R., Russell, R. K., Edwards, C. A., Talwar, D., McGrogan, P., & Gerasimidis, K. (2021). Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet. Clinical Nutrition, 40(5), 2784-2790. https://doi.org/10.1016/j.clnu.2021.03.006

@article{adf3905709b4467b90742bc7ede2c69d,

title = "Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet",

abstract = "Introduction: In coeliac disease (CD) micronutrient deficiencies may occur due to malabsorption in active disease and diminished intake during treatment with a gluten-free diet (GFD). This study assessed the micronutrient status in children with CD at diagnosis and follow-up.Methods: Fifteen micronutrients were analysed in 106 blood samples from newly diagnosed CD and from patients on a GFD for <6 months, 6-12 months and with longstanding disease (> 12 months). Predictors of micronutrient status included: demographics, disease duration, anthropometry, gastrointestinal symptoms, raised tissue transglutaminase antibodies (TGA), multivitamin use and faecal gluten immunogenic peptide (GIP). Micronutrient levels were compared against laboratory reference values.Results: At CD diagnosis (n = 25), low levels in > 10% of patients were observed for: vitamins E (88%), B1 (71%), D (24%), K (21%), A (20%) and B6 (12%), ferritin (79%), and zinc (33%). One year post-diagnosis, repletion of vitamins E, K, B6 and B1 was observed (<10% patients). In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis. Copper, selenium and magnesium did not differ significantly between diagnosis and follow-up. All samples for B2, folate, vitamin C (except for one sample) and B12 were normal. A raised TGA at follow-up was associated with low vitamins A and B1 (raised vs normal TGA; vitamin A: 40% vs 17%, p = 0.044, vitamin B1: 37% vs 13%, p = 0.028). Low vitamin A (p = 0.009) and vitamin D (p = 0.001) were more common in samples collected during winter. There were no associations between micronutrient status with GIP, body mass index, height, socioeconomic status, or gastrointestinal symptom. Multivitamin use was less common in patients with low vitamin D. Conclusions: Several micronutrient deficiencies in CD respond to a GFD but others need to be monitored long-term and supplemented where indicated.(c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.",

keywords = "Celiac disease, Micronutrient, Gluten free diet, Vitamin, Trace element, Children, DIAGNOSIS, ERYTHROCYTES, MANAGEMENT, NUTRITION, VITAMIN",

author = "Lorcan McGrogan and Mary Mackinder and Fiona Stefanowicz and Maria Aroutiounova and Anthony Catchpole and John Wadsworth and Elaine Buchanan and Tracey Cardigan and Hazel Duncan and Richard Hansen and Russell, {Richard K.} and Edwards, {Christine A.} and Dinesh Talwar and Paraic McGrogan and Konstantinos Gerasimidis",

year = "2021",

month = may,

doi = "10.1016/j.clnu.2021.03.006",

language = "English",

volume = "40",

pages = "2784--2790",

journal = "Clinical Nutrition",

issn = "0261-5614",

publisher = "Churchill Livingstone",

number = "5",

}

McGrogan, L, Mackinder, M, Stefanowicz, F, Aroutiounova, M, Catchpole, A, Wadsworth, J, Buchanan, E, Cardigan, T, Duncan, H, Hansen, R, Russell, RK, Edwards, CA, Talwar, D, McGrogan, P & Gerasimidis, K 2021, 'Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet', Clinical Nutrition, vol. 40, no. 5, pp. 2784-2790. https://doi.org/10.1016/j.clnu.2021.03.006

TY - JOUR

T1 - Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

AU - McGrogan, Lorcan

AU - Mackinder, Mary

AU - Stefanowicz, Fiona

AU - Aroutiounova, Maria

AU - Catchpole, Anthony

AU - Wadsworth, John

AU - Buchanan, Elaine

AU - Cardigan, Tracey

AU - Duncan, Hazel

AU - Hansen, Richard

AU - Russell, Richard K.

AU - Edwards, Christine A.

AU - Talwar, Dinesh

AU - McGrogan, Paraic

AU - Gerasimidis, Konstantinos

PY - 2021/5

Y1 - 2021/5

N2 - Introduction: In coeliac disease (CD) micronutrient deficiencies may occur due to malabsorption in active disease and diminished intake during treatment with a gluten-free diet (GFD). This study assessed the micronutrient status in children with CD at diagnosis and follow-up.Methods: Fifteen micronutrients were analysed in 106 blood samples from newly diagnosed CD and from patients on a GFD for <6 months, 6-12 months and with longstanding disease (> 12 months). Predictors of micronutrient status included: demographics, disease duration, anthropometry, gastrointestinal symptoms, raised tissue transglutaminase antibodies (TGA), multivitamin use and faecal gluten immunogenic peptide (GIP). Micronutrient levels were compared against laboratory reference values.Results: At CD diagnosis (n = 25), low levels in > 10% of patients were observed for: vitamins E (88%), B1 (71%), D (24%), K (21%), A (20%) and B6 (12%), ferritin (79%), and zinc (33%). One year post-diagnosis, repletion of vitamins E, K, B6 and B1 was observed (<10% patients). In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis. Copper, selenium and magnesium did not differ significantly between diagnosis and follow-up. All samples for B2, folate, vitamin C (except for one sample) and B12 were normal. A raised TGA at follow-up was associated with low vitamins A and B1 (raised vs normal TGA; vitamin A: 40% vs 17%, p = 0.044, vitamin B1: 37% vs 13%, p = 0.028). Low vitamin A (p = 0.009) and vitamin D (p = 0.001) were more common in samples collected during winter. There were no associations between micronutrient status with GIP, body mass index, height, socioeconomic status, or gastrointestinal symptom. Multivitamin use was less common in patients with low vitamin D. Conclusions: Several micronutrient deficiencies in CD respond to a GFD but others need to be monitored long-term and supplemented where indicated.(c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

AB - Introduction: In coeliac disease (CD) micronutrient deficiencies may occur due to malabsorption in active disease and diminished intake during treatment with a gluten-free diet (GFD). This study assessed the micronutrient status in children with CD at diagnosis and follow-up.Methods: Fifteen micronutrients were analysed in 106 blood samples from newly diagnosed CD and from patients on a GFD for <6 months, 6-12 months and with longstanding disease (> 12 months). Predictors of micronutrient status included: demographics, disease duration, anthropometry, gastrointestinal symptoms, raised tissue transglutaminase antibodies (TGA), multivitamin use and faecal gluten immunogenic peptide (GIP). Micronutrient levels were compared against laboratory reference values.Results: At CD diagnosis (n = 25), low levels in > 10% of patients were observed for: vitamins E (88%), B1 (71%), D (24%), K (21%), A (20%) and B6 (12%), ferritin (79%), and zinc (33%). One year post-diagnosis, repletion of vitamins E, K, B6 and B1 was observed (<10% patients). In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis. Copper, selenium and magnesium did not differ significantly between diagnosis and follow-up. All samples for B2, folate, vitamin C (except for one sample) and B12 were normal. A raised TGA at follow-up was associated with low vitamins A and B1 (raised vs normal TGA; vitamin A: 40% vs 17%, p = 0.044, vitamin B1: 37% vs 13%, p = 0.028). Low vitamin A (p = 0.009) and vitamin D (p = 0.001) were more common in samples collected during winter. There were no associations between micronutrient status with GIP, body mass index, height, socioeconomic status, or gastrointestinal symptom. Multivitamin use was less common in patients with low vitamin D. Conclusions: Several micronutrient deficiencies in CD respond to a GFD but others need to be monitored long-term and supplemented where indicated.(c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

KW - Celiac disease

KW - Micronutrient

KW - Gluten free diet

KW - Vitamin

KW - Trace element

KW - Children

KW - DIAGNOSIS

KW - ERYTHROCYTES

KW - MANAGEMENT

KW - NUTRITION

KW - VITAMIN

U2 - 10.1016/j.clnu.2021.03.006

DO - 10.1016/j.clnu.2021.03.006

M3 - Article

C2 - 33933744

SN - 0261-5614

VL - 40

SP - 2784

EP - 2790

JO - Clinical Nutrition

JF - Clinical Nutrition

IS - 5

ER -

Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

Abstract

Access to Document

Fingerprint

Cite this