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Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets
Lorenzo Norsa1, Raanan Shamir, Noam Zevit
1Lorenzo Norsa, Elvira Verduci, Diana Ghisleni, Enrica Riva, Marcello Giovannini, Department of Pediatrics, San Paolo Hospital University of Milan, 20142 Milan, Italy.
Insights
Children with celiac disease (CD) on a gluten-free diet (GFD) show increased cardiovascular disease (CVD) risk factors, including high triglycerides and borderline LDL cholesterol. This highlights the need for CVD screening and dietary counseling in these patients.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Cardiovascular Health
Background:
- Celiac disease (CD) requires a strict gluten-free diet (GFD).
- Long-term adherence to GFD may influence metabolic health.
- Cardiovascular disease (CVD) risk factors in children with CD are not fully understood.
Purpose of the Study:
- To assess cardiovascular disease (CVD) risk factors in children diagnosed with celiac disease (CD) and adhering to a gluten-free diet (GFD).
- To compare CVD risk factors in CD patients on a GFD with their baseline values at diagnosis.
Main Methods:
- A cross-sectional, multicenter study involving 114 children with CD in serologic remission on a GFD for at least one year.
- Measurements included anthropometrics, blood lipids, glucose, and calculation of insulin resistance (HOMA-IR).
- Data were compared to baseline values at diagnosis.
Main Results:
- 14% of children on a GFD had three or more CVD risk factors.
- Common risk factors included high triglycerides (34.8%), elevated blood pressure (29.4%), and borderline LDL cholesterol (24%).
- Trends showed increased overweight and obesity rates on GFD, with higher insulin resistance noted in one cohort.
Conclusions:
- Children with celiac disease on a gluten-free diet exhibit significant cardiovascular disease risk factors.
- Routine screening for CVD risk factors is crucial for pediatric CD patients.
- Targeted dietary counseling is essential for CVD prevention in this population.
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.
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