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Bones loss in children with celiac disease does not depend on the presence of symptoms

Cynthia Schuck, Specialgourmets — Mon, 03 Aug 2009 22:29:34 +0000

Given (intentional or non-intentional) dietary gluten exposure, growing children with celiac disease may experience poor absorption of nutrients, negatively affecting bone health. Now a new study published in the Journal of Pediatric Gastroenterology and Nutrition by Canadian researchers from University of Alberta and the Alberta Health Services shows that loss of bone density in celiac children does not depend on the presence of symptoms at diagnosis. Moreover, the research revealed that the older the age at which the child was diagnosed, the higher the likelihood of bone loss.

The researchers studied 74 children aged between 3 and 16 years, and analyzed bone mineral density of the spine to determine the presence and degree of bone loss. An equivalent reduction in spine bone mass was observed in children with celiac disease at diagnosis regardless of the presence of symptoms. However, bone density was inversely correlated with age at diagnosis.

The researchers conclude their study by suggesting that delayed diagnosis of children with celiac disease may increase the risk of adult osteoporosis and that, even in the absence of symptoms, appropriate screening of children at risk of celiac disease for the purpose of early diagnosis, as well as routine evaluation of bone mineral density in such children, are important to prevent long-term complications associated with poor bone health.

Source: Prevalence of Metabolic Bone Disease in Children With Celiac Disease Is Independent of Symptoms at Diagnosis. Journal of Pediatric Gastroenterology and Nutrition. Turner, Justine; Pellerin, Genevieve; Mager, Diana. 2009 Jul 28. [Epub ahead of print]Similar Posts:

Celiac disease may strike the elderly too

Cynthia Schuck, Specialgourmets — Mon, 03 Aug 2009 22:29:04 +0000

Celiac disease doesn’t only affect the young, new research from Finland confirms, but can strike a person for the first time in later life.

Source: Reuters Health, July 24,2009

In people with celiac disease, eating gluten-a protein found in many types of grain-causes the immune system to launch an attack on the small intestine. While people may think of the condition as a problem for children and young adults, they add, Vilppula and her team recently identified cases of celiac disease in elderly people. In some individuals, the condition had not been detected.

In the current study, the researchers investigated whether some older people had actually developed celiac disease later in their lives, or the disease had simply gone undetected. They looked at 2,815 people over 55 who had undergone blood tests for celiac disease in 2002, 2,216 of whom were screened again in 2005. The researchers also did biopsies of patients’ small intestines to confirm the blood test findings.

In 2002, 2.13% of the study participants had biopsy-confirmed celiac disease, while 2.34% did in 2005. There were five new cases among people whose blood tests had initially been negative for the disease, and only two of these individuals had symptoms. That led the researchers to conclude that the elderly could develop the disease late in life.

Past research has shown that undetected celiac disease can lead to significant health problems in older people, the researchers note; in one study including 35 people 60 and older, 15 had been seeing their doctor for 28 years, on average, with symptoms without being diagnosed.

Doctors should be aware of the possibility that their older patients may have or develop celiac disease, Vilppula and colleagues say, and they should use blood tests to confirm the diagnosis-even though a negative test doesn’t mean a person won’t develop the condition later on.

SOURCES:
Reuters Health, July 24,2009
BMC Gastroenterology, online June 29, 2009.Similar Posts:

Complete adherece to gluten-free diet still low

Cynthia Schuck, Specialgourmets — Thu, 18 Jun 2009 12:51:42 +0000

The proportion of celiacs following a strict gluten-free diet is still low, a new study reports

A review article just published in the last issue of Alimentary Pharmacology & Therapeutics by researchers from the Universities of Sunderland and Durham in the UK reveals that adherence to a gluten-free diet is still poor even by those with a confirmed diagnose of celiac disease.

After a literature review which considered 38 articles of relevance mostly in the United Kingdom and other European countries, the authors found out that, although complete non-adherence is rare in celiac patients, up to 60% of the patients investigated in these studies showed some level of non-adherence (intentional and unintentional) to the gluten-free diet (as measured by self-reports, dietary interviews, histological and serological tests). According to the authors, this number could be even higher, as people who do not follow a strict gluten-free diet might be less likely to agree to participate in research or return questionnaires, leading to an overestimation of rates of adherence to the diet.

The review suggests that the ability to comply with the gluten-free diet is most strongly associated with cognitive, emotional and socio-cultural influences. For example, the ability to follow the diet when travelling, dining out, at work or at social events has been found to be significantly associated with adherence. Membership of an advocacy group and regular dietetic follow-up also seemed to increase the likelihood of compliance with the diet. Although other factors – such as demography, age at diagnosis, socio-economic status and education – were also examined, no firm conclusions could be drawn due to variable existing evidence in each case.

The researchers conclude their study by highlighting that further research is needed to characterise those individuals most likely to be non-adherent in order to better assist them with their treatment. Hopefully the higher availability of gluten-free products, better regulations and increased level of awareness about the disease can soon change this scenario.

More information: Hall NJ, Rubin G, Charnock A. 2009. Systematic review: Adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther.Similar Posts:

Research status of the GFCF diet in the treatment of autism

Cynthia Schuck, Specialgourmets — Thu, 18 Jun 2009 12:51:22 +0000

The current research status of the gluten-free, casein-free diet in the treatment of autism

Treatment for Autism – a complex disorder that hampers the ability to communicate and behave socially – usually consists of comprehensive educational programs, developmental therapies, and behavioral treatment. Several different nutritional strategies have also been suggested, such as the restriction of food allergens, the yeast-free diet, and the use of probiotics and dietary supplements. Among these, one of the most popular interventions is the gluten-free/casein-free (GFCF) diet, a diet that eliminates gluten (found in wheat, barley and rye) and casein (found in dairy products).

A recent article, published in Nutrition and Clinical Practice by Dr. Jennifer Elder reviews the current scientific status of the GFCF diet, and provides advice for families and health professionals to use in deciding if a trial of the GFCF diet is in the best interest of their child and family. Here we summarize the main points highlighted by the researcher.

As she describes, one of the main hypotheses behind the adoption of the GFCF diet is the idea that some autistic symptoms and behaviors may be the result of an excess of opioid peptides (a chemical substance that has morphine like action) in the body. The hypotheses postulates that the increased intestinal permeability frequently found in autistic individuals allows large peptides formed from the incomplete digestion of gluten and casein to cross the intestinal membrane. These large peptides derived from the breakdown of gluten and casein would act as opioids produced naturally in the body, entering the bloodstream and then crossing the blood-brain barrier. The resulting excess of opioids within the central nervous system is thought to lead to some behaviors noted in autistic children, with the removal of these substances from the diet hence paralleling a change in autistic behaviors in some children.

Results of the GFCF Diet Trials in Autism

The results from the scientific studies conducted to examine the effects of the diet on the improvement of symptoms are still preliminary, as a larger number of participants, as well as more rigorous control of compliance to the diet and standardized diagnostic measures would be necessary to enable firm conclusions to be drawn. Here is a summary of the main findings reviewed:

- In a study from 2003 involving 50 children with autism, blood analysis revealed that a significant number of the children developed antibodies against casein and gliadin.
- Another study involving 20 participants, showed that, although changes were observed both in the group following the GFCF diet and that following a regular diet (control group), the group following the diet had a significant improvement in autistic behavior, nonverbal cognitive level, and motor problems compared with those in the control group.
- Finally, a study published in the Journal of Autism and Related Disorders involving 13 children and a more rigorous control of the diagnostic measures implemented the diet for a 12-week period. This study showed that, while there were some anecdotal parent and teacher reports of positive dietary effects on language and behavior, the statistical analysis of the group as a whole did not show differences in their behaviors (it is interesting to note here that 7 of the 13 families in the study reported improvements – increased child language, decreased hyperactivity, decreased tantrums – that were not corroborated by the diagnostic measures used by the researchers). The authors acknowledge however that a longer period might be necessary to compensate for the possibility that children following the diet ‘sneak’ food, and the fact that some children may take longer to show improvements.

Implementing the Diet

Although the scientific results are still preliminary, and more research is still needed, Dr. Jennifer considers the GFCF diet as a promising intervention. However, she urges families and nutrition professionals to regularly evaluate the pros and cons of all dietary approaches to treatment, and consider the following questions when weighing the pros and cons of implementing the GFCF diet:

1. Can the family afford the often expensive foods in the GFCF diet, and are these readily available?

2. Has the family considered the extra time and effort that may be needed to prepare the diet?

3. Is there a commitment by at least 1 family member to keep accurate daily records of food intake and behavioral changes?

4. Will it be possible to ensure dietary compliance at home and, when applicable, at school?

5. Is there a family member or professional who can offer practical advice for preparing and implementing the diet?

6. Are there professionals in the geographical area who might assist in evaluating the diet?

7. What is the overall health status of the child?

8. Is there a plan for regular monitoring? (this is important, since reports of bone loss and amino acid deficiencies in children who have been on the GFCF diet suggest that nutrition status should be constantly monitored and that, in some cases, supplemental vitamins and minerals may be indicated)

9. Does the child have a limited food repertoire that, if further limited by the GFCF diet, might result in a dangerously compromised nutrition status?

Future research

Currently there are two studies being conducted, one in Norway (http://clinicaltrials.gov/ct2/show/NCT00614198), and another in the United States (http://clinicaltrials.gov/ct2/show/NCT00090428?term=autism+diet%26rank=2). As scientists await further evidence about the effectiveness of the diet in the improvement of the symptoms, it is important to carefully consider the pros and cons of the diet to ensure the health of children under any dietary intervention.

More information: Elder JH. 2009. The gluten-free, casein-free diet in autism: an overview with clinical implications. Nutr Clin Pract. 23Similar Posts: