Muscle Strength and Nutritional Status in Adults With Celiac Disease: A Prospective Case-Control Study

Nutritional assessment in celiac disease (CeD) commonly relies on body weight, biochemical abnormalities, and conventional nutritional screening, although these measures may not fully capture muscle health. We compared muscle mass, muscle strength, physical performance, and nutritional risk between adults with CeD and healthy controls and examined whether low muscle strength was associated with conventional nutritional risk orcurrent dietary/serological status.

This prospective case-control study included 119 adults with CeD and 119 controls. Nutritional risk was assessed using the Malnutrition Universal Screening Tool (MUST). Anthropometry and bioelectrical impedance analysis were used to assess nutritional status and body composition. Handgrip strength and 4-m gait speed were measured. In a post hoc age-restricted analysis, prospectively collected handgrip measurements from participants aged 20-39 years were reclassified using recently established reference values for healthy Turkish adults; low muscle strength was defined as <16 kg in women and <26 kg in men.

Patients with CeD had lower skeletal muscle mass (26.26±4.77 vs 30.52±7.92 kg), handgrip strength (33.92±17.77 vs 44.48±12.46 kg), and gait speed (1.14±0.15 vs 1.27±0.16 m/s) than controls (all p<0.001). BMI, fat-free mass, mid-upper arm circumference, calf circumference, and triceps skinfold thickness were also lower in CeD. Medium/highMUST risk was present in 34.5% of patients and in none of the controls (p<0.001). Among participants aged 20-39 years, low muscle strength was identified in 7 of 79 patients with CeD (8.9%) and in 0 of 78 controls (p=0.014). Within this age-restricted CeD subgroup, low muscle strength was numerically more frequent with medium/highMUST risk than with low MUST risk (17.9% vs 3.9%, p=0.090) and did not differ significantly by current dietary/serological status(10.2% vs 5.0%, p=0.672).

Adults with CeD demonstrated lower muscle mass, strength, and physical performance than controls. In the age range for which contemporary Turkish handgrip reference values are available, low muscle strength occurred in a subset of patients and was not significantly associated with MUST-defined nutritional risk orcurrent dietary/serological status. Direct assessment of muscle health may therefore provide complementary information beyond routine nutritional screening in adults with CeD.