Impact of compliance to a gluten-free diet on vitamin and trace element deficiencies in celiac patients

Abstract

Background. Celiac disease (CD) is a chronic immune-mediated disorder characterized by growth retardation and malabsorbtion related to mucosal damage and inflammation of small intestine in genetically predisposed people as a result of gluten exposure. In CD treatment, clinical, histological and serological improvement is possible with gluten-free diet. Thus, we aimed to assess the vitamin and trace element levels of CD patients in regard to their compliance with gluten-free diet. Materials and methods. In our study, 77 patients diagnosed with CD were evaluated retrospectively. All individuals were assessed with Marsh classification histopathologically and surveyed when they follow a gluten-free diet. Demographic features, age of disease onset, physical examination findings, anthropometric measurements and laboratory findings along with clinical and laboratory outcomes of patients after a gluten-free diet were compared between compliant to diet and non-compliant to diet groups. Results. A total of 77 individuals, 48 females and 29 males with a diagnosis of CD and mean age of 9.81 ± 4.73 years on admission, were reqruited in our study. Patients were mostly found to have Marsh type 3a (n = 22) and Marsh type 3b (n = 20) histopathologically. The results of serological screening revealed that 40.3 % of people (n = 31) were compliant with diet whereas 59.7 % (n = 46) — non-compliant. Non-compliant group had significantly lower mean vitamin B₁₂, vitamin D, folate, zinc and selenium levels compared to compliant group (p = 0.000; 0.000; 0.000; 0.000 and 0.031, respectively). In addition, a significantly higher mean serum total IgA level was detected in non-compliant group in comparison to compliant group (p = 0.027). Conclusions. High efficacy of gluten-free diet in correcting nutritional insufficiencies and deficiencies was shown. Thus, there is no doubt that informing patients and their families about lifelong gluten-free diet in detail is beneficial although this treatment contains many social and practical difficulties.