The Impact of a Gluten-free Diet on the Nutritional Status of Pediatric Patients with Celiac Disease

Yıl 2024, Cilt: 7 Sayı: 1, 32 - 42, 29.01.2024

Yasemin Ertaş Öztürk , Efsun Karabudak , Odul Egritas

https://doi.org/10.53493/avrasyasbd.1308399

Öz

Aim: Evaluating the effect of a gluten-free diet on the nutritional status of children with celiac disease was aimed.
Materials and Method: Eleven children recently diagnosed with celiac disease were included in this study. The children's diets were given by a dietitian and followed for six months. Three-day food consumption records and anthropometric measurements were taken before and after the gluten-free diet. Nutrient intake was calculated, and food consumption was evaluated regarding the recommendations of the Turkish Dietary Guidelines. By determining height and body weight according to age, z-score calculations were made, classified, and compared.
Results: The ages of the children who participated in this study ranged from three to 12 years old. After the gluten-free diet, it was observed that the percentage of energy which was derived from sucrose decreased (p<0.05). It was also seen that the children started to consume more from the milk and milk products group, green-leaved vegetables, and other vegetables except for potatoes. It was observed that the participants’ sugar and sweet foods consumption decreased (p<0.05). After six months, the proportion of children classified as "short" in height with regard to age decreased (45.5% before the diet, 27.3% after).
Conclusion and Suggestions: The findings obtained in this study suggest that the gluten-free diet is planned correctly, adequate energy and nutrient intake can be achieved. It has been observed that the nutritional status of the children has improved after the follow-up. Regularly following gluten-free diets after planning and providing dietitian support is essential in ensuring optimum nutrition.

Anahtar Kelimeler

Celiac disease, dietitian, nutrient, food consumption, growth

Destekleyen Kurum

Gazi University Scientific Research Projects (BAP) unit

Proje Numarası

47/2019-02

Glutensiz Diyetin Çölyak Hastalığı Olan Çocukların Beslenme Durumuna Etkisi

Öz

Amaç: Bu çalışmada çölyak tanısı alan çocukların glutensiz diyet öncesi ve sonrasında beslenme durumlarının değerlendirilmesi amaçlanmıştır.
Yöntem: Çalışmaya yeni tanı alan 11 çölyaklı çocuk dâhil edilmiştir. Çocukların diyetleri diyetisyen tarafından düzenlenmiş ve altı ay boyunca takip edilmiştir. Çocukların diyet öncesi ve sonrasında üç günlük besin tüketimler kayıtları ve antropometrik ölçümleri alınmıştır. Besin ögesi alımları hesaplanmış ve besin tüketimleri Türkiye Beslenme Rehberi önerileri doğrultusunda değerlendirilmiştir. Yaşa göre boy ve vücut ağırlığı belirlenerek z-skor hesaplamaları yapılmış, sınıflandırılarak karşılaştırılmıştır.
Bulgular: Çocukların yaşları 3-12 yıl arasında değişmektedir. Glutensiz diyet sonrasında öncesine göre enerjinin sükrozdan gelen yüzdesinde azalma sağlanmıştır (p<0.05). Çocukların süt ve ürünleri grubunu, yeşil yapraklı sebzeler ile patates hariç diğer sebzeleri daha fazla tüketmeye başladığı, şekerli besinleri ise azalttığı gözlemlenmiştir (p<0.05). Altıncı ayda yaşa göre boy uzunluğu “kısa” sınıflamasına dâhil çocukların oranında azalma görülmüştür (diyet öncesi %45.5, sonrası: %27.3).
Sonuç: Glutensiz diyet tedavisi doğru planlanmadığı takdirde besin ögesi ve besin alımlarında dengesizlikler görülebilir. Bu çalışmada izlem sonrası çocukların beslenme durumlarının iyileştiği gözlenmiştir. Glutensiz diyetlerin planlandıktan sonra düzenli takip edilmesi ve hekim ve diyetisyen işbirliğinin sağlanması optimum beslenmenin sağlanmasında önemlidir.

Anahtar Kelimeler

Çölyak hastalığı, diyetisyen, besin ögesi, besin tüketimi, büyüme

Proje Numarası

47/2019-02

Kaynakça

• Babio N, Alcázar M, Castillejo G, Recasens M, Martínez-Cerezo F, Gutiérrez-Pensado V, Masip G, Vaqué C, Vila-Martí A, Torres-Moreno M, Sánchez E, Salas-Salvadó J. (2017). Patients with celiac disease reported higher consumption of added sugar and total fat than healthy individuals. J Pediatr Gastroenterol Nutr, 64 (1): 63-69.
• Bagolin do Nascimento A, Medeiros Rataichesck Fiates G, dos Anjos A,Teixeira E. (2014). Availability, cost and nutritional composition of gluten-free products. Br Food J, 116 (12): 1842-1852.
• Bai JC, Ciacci C. (2017). World gastroenterology organisation global guidelines: Celiac disease February 2017. J Clin Gastroenterol, 51 (9): 755-768.
• Balamtekin N, Aksoy Ç, Baysoy G, Uslu N, Demir H, Köksal G, Saltık-Temizel İN, Özen H, Gürakan F, Yüce A. (2015). Is compliance with gluten-free diet sufficient? Diet composition of celiac patients. Turk J Pediatr, 57 (4): 374- 379.
• Bascunan KA, Vespa MC, Araya M. (2017). Celiac disease: understanding the gluten-free diet. Eur J Nutr, 56 (2): 449- 459.
• Blössner M, Siyam A, Borghi E, De Onis M, Onyango A,Yang H. (2007). WHO Anthro for personal computers manual: software for assessing growth of the world’s children. World Health Organization: Geneva, Switzerland.
• Blössner M, Siyam A, Borghi E, Onyango A, De Onis M. (2009). WHO AnthroPlus for personal computers manual: software for assessing growth of the world’s children and adolescents. World Health Organization: Geneva, Switzerland.
• Brambilla P, Picca M, Dilillo D, Meneghin F, Cravidi C, Tischer M, Vivaldo T, Bedogni G, Zuccotti GV. (2013). Changes of body mass index in celiac children on a gluten-free diet. Nutr Metab Cardiovasc Dis, 23 (3): 177-182.
• Calvo-Lerma J, Crespo-Escobar P, Martínez-Barona S, Fornés- Ferrer V, Donat E,Ribes-Koninckx C. (2019). Differences in the macronutrient and dietary fibre profile of gluten-free products as compared to their gluten-containing counterparts. Eur J Clin Nutr, 73 (6): 930-936.
• Cornicelli M, Saba M, Machello N, Silano M,Neuhold S. (2018). Nutritional composition of gluten-free food versus regular food sold in the Italian market. Dig Liver Dis, 50 (12): 1305- 1308.
• Dennis M, Lee AR,McCarthy T. (2019). Nutritional considerations of the gluten-free diet. Gastroenterology Clinics, 48 (1): 53- 72.
• Di Nardo G, Villa MP, Conti L, Ranucci G, Pacchiarotti C, Principessa L, Raucci U, Parisi P. (2019). Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review. Nutrients, 11 (7): 1-12.
• Dickson B, Streutker C,Chetty R. (2006). Coeliac disease: an update for pathologists. J Clin Pathol, 59 (10): 1008-1016.
• Ertaş-Öztürk Y. (2019). Çölyaklı Çocuklarda Glutensiz Diyet Tedavisinin İntestinal Mikrobiyotaya Etkisi. Doktora Tezi. Gazi Üniversitesi, Sağlık Bilimleri Enstitüsü, Beslenme ve Diyetetik Anabilim Dalı. Ankara.
• Esenyel S, Unal F,Vural P. (2014). Depression and anxiety in child and adolescents with follow-up celiac disease and in their families. Turk J Gastroenterol, 25 (4): 381-385.
• Ferrara P, Cicala M, Tiberi E, Spadaccio C, Marcella L, Gatto A, Calzolari P, Castellucci G. (2009). High fat consumption in children with celiac disease. Acta Gastroenterol Belg, 72 (3): 296-300.
• Gobbetti M, Pontonio E, Filannino P, Rizzello CG, De Angelis M,Di Cagno R. (2018). How to improve the gluten-free diet: The state of the art from a food science perspective. Food Res Int, 110: 22-32.
• González MP, Ballestero-Fernández C, Fajardo V, Achón M, García-González Á, Alonso-Aperte E, Úbeda N. (2022). Gluten-free product contribution to energy and macronutrient intakes in Spanish children and adolescents with celiac disease. Foods, 11 (23): 3790.
• Graziano Barera, Stefano Mora, Paolo Brambilla, Alberto Ricotti, Laura Menni, Sabrina Beccio,Bianchi C. (2000). Body composition in children with celiac disease and the effects of a gluten-free diet: a prospective case-control study. Am J Clin Nutr, 72 (1): 71-75.
• Hill ID, Fasano A, Guandalini S, Hoffenberg E, Levy J, Reilly N, Verma R. (2016). NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders. J Pediatr Gastroenterol Nutr, 63 (1): 156-165.
• Hopman EGD, le Cessie S, von Blomberg BME, Mearin ML. (2006). Nutritional Management of the Gluten-free Diet in Young People with Celiac Disease in The Netherlands. J Pediatr Gastroenterol Nutr, 43 (1): 102-108.
• Kahrs CR, Magnus MC, Stigum H, Lundin KEA,Stordal K. (2017). Early growth in children with coeliac disease: a cohort study. Arch Dis Child, 102 (11): 1037-1043.
• Kautto E, Ivarsson A, Norström F, Högberg L, Carlsson A,Hörnell A. (2014). Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries. J Hum Nutr Diet, 27 (1): 41-53.
• Leffler DA, Green PH,Fasano A. (2015). Extraintestinal manifestations of coeliac disease. Nat Rev Gastroenterol Hepatol, 12 (10): 561-571.
• Lundin KE,Wijmenga C. (2015). Coeliac disease and autoimmune disease-genetic overlap and screening. Nat Rev Gastroenterol Hepatol, 12 (9): 507-515.
• MacCulloch K,Rashid M. (2014). Factors affecting adherence to a gluten-free diet in children with celiac disease. Paediatr Child Health, 19 (6): 305-309.
• Macdonald S. (2007). Gastroenterology. In; Clinical Paediatric Dietetics, Shaw V (ed). 4th ed. Blackwell Publishing, Oxford.
• Martín-Masot R, Labella A, Baena-García L, Flor-Alemany M, López-Frías M, de la Higuera M, Maldonado J, Nestares, T. (2022). Time Following a Gluten-Free Diet, Ultra-Processed Food Consumption and Quality of Life in Children with Celiac Disease. Applied Sciences, 12 (22): 11680.
• Melini V, Melini F. (2019). Gluten-Free Diet: Gaps and Needs for a Healthier Diet. Nutrients, 11 (1): 170-191.
• Missbach B, Schwingshackl L, Billmann A, Mystek A, Hickelsberger M, Bauer G, Konig J. (2015). Gluten-free food database: the nutritional quality and cost of packaged gluten-free foods. Peer J, 3: 1337-1355.
• Nachman F, Maurino E, Vazquez H, Sfoggia C, Gonzalez A, Gonzalez V, Plancer del Campo M, Smecuol E, Niveloni S, Sugai E, Mazure R, Cabanne A, Bai JC. (2009). Quality of life in celiac disease patients: prospective analysis on the importance of clinical severity at diagnosis and the impact of treatment. Dig Liver Dis, 41 (1): 15-25.
• Niewinski MM. (2008). Advances in celiac disease and gluten-free diet. J Am Diet Assoc, 108 (4): 661-672.
• Öhlund K, Olsson C, Hernell O,Öhlund I. (2010). Dietary shortcomings in children on a gluten-free diet. J Hum Nutr Diet, 23 (3): 294-300.
• Pekcan G. (2008). Beslenme durumunun saptanması. In; Diyet El Kitabı, Baysal A (ed). Ankara: Hatiboğlu Yayınevi.
• Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti G. (2013). Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients, 5 (11): 4553-4565.
• Quero JS, Jaime BE, Martínez AR, Martín FA, Jiménez RG, Murillo MR,Martín AP. (2015). Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient? An Pediatr, 83 (1): 33-39.
• Reilly NR, Aguilar K, Hassid BG, Cheng J, Defelice AR, Kazlow P, Bhagat G, Green PH. (2011). Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr, 53 (5): 528-531.
• Roma E, Roubani A, Kolia E, Panayiotou J, Zellos A,Syriopoulou VP. (2010). Dietary compliance and life style of children with coeliac disease. J Hum Nutr Diet, 23 (2): 176-182.
• Rybicka I. (2018). The handbook of minerals on a gluten-free diet. Nutrients, 10 (11): 1683-1691.
• TC Sağlık Bakanlığı (2016). Türkiye Beslenme Rehberi 2015. 1st ed. Ankara.
• Saturni L, Ferretti G,Bacchetti T. (2010). The gluten-free diet: safety and nutritional quality. Nutrients, 2 (1): 16-34.
• See JA, Kaukinen K, Makharia GK, Gibson PR,Murray JA. (2015). Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol, 12 (10): 580-591.
• Segura MEM, Rosell CM. (2011). Chemical composition and starch digestibility of different gluten-free breads. Plant Foods Hum Nutr, 66 (3): 224-230.
• Sue A, Dehlsen K,Ooi CY. (2018). Paediatric patients with coeliac disease on a gluten-free diet: Nutritional adequacy and macro-and micronutrient imbalances. Curr Gastroenterol Rep, 20 (1): 2.
• Valitutti F, Iorfida D, Anania C, Trovato CM, Montuori M, Cucchiara S,Catassi C. (2017). Cereal consumption among subjects with celiac disease: a snapshot for nutritional considerations. Nutrients, 9 (4): 396-406.
• Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F,Danchielli C. (2010). Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr, 64 (11): 1371-1372.
• Van Hees NJ, Giltay EJ, Tielemans SM, Geleijnse JM, Puvill T, Janssen N,Van Der Does W. (2015). Essential amino acids in the gluten-free diet and serum in relation to depression in patients with celiac disease. PloS One, 10 (4): 122619- 122633.
• Van Rijn J, Grote F, Oostdijk W, Wit J. (2004). Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms. Arch Dis Child, 89 (9): 882-883.
• Venkatasubramani N, Telega G, Werlin SL. (2010). Obesity in pediatric celiac disease. J Pediatr Gastroenterol Nutr, 51 (3): 295-297.
• Vereczkei Z, Dergez T, Fodor Z, Szakács Z, Bajor J. (2023). Body Mass Index during Gluten-Free Diet in Patients with Celiac Disease. Nutrients, 15 (16): 3517.
• Zuccotti G, Fabiano V, Dilillo D, Picca M, Cravidi C, Brambilla P. (2013). Intakes of nutrients in I talian children with celiac disease and the role of commercially available gluten-free products. J Hum Nutr Diet, 26 (5): 436-444.