Impacto de la dieta sin gluten sobre la composición corporal de población infantil con enfermedad celíaca

Abstract

Celiac disease (CD) is a chronic autoimmune condition induced by the ingestion of gluten and related prolamins in genetically vulnerable individuals. The sole available treatment is a strict and lifelong gluten-free diet (GFD), which can be challenging to adhere to. In children, maintaining a balanced diet is essential for optimal health to avoid growth difficulties. Poor compliance and quality of the GFD in development age children with CD can have severe consequences for their growth and, specifically, for their body composition and bone health. Thus, ensuring that children with CD are consuming a balanced and varied diet that meets their nutritional needs during growth is critical, in addition to adhering strictly and continuously to the GFD. This study's purpose was to evaluate the impact of GFD quality on body composition and bone status among children with CD. The study involved 59 children with CD and 40 healthy children. Children with CD were divided into two groups based on their adherence to the GFD: ≥18 months or <18 months. All participants underwent assessments of body composition and bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) and provided dietary, quality life, GFD adherence and physical activity (PA) questionnaires. The study’s results revealed that children with CD show lower intakes of protein, MGA and complex carbohydrates and fiber, but higher intakes of saturated fats than healthy children. In addition, the celiac dietary pattern shows reduced intake of certain micronutrients such as iron, phosphorus, magnesium, zinc and folate. Moreover, CD children had less body weight, lean mass, bone mineral content, and BMD Z-score than healthy children, even after accounting for possible confounding factors such as age, sex, and GFD follow-up time. However, children with CD who engaged in more intense forms of PA showed greater lean mass and BMD levels, irrespective of their adherence time to the GFD. Additionally, higher adherence to the Mediterranean Diet was linked to a higher BMD Z-score. A strong correlation was found between lean mass and BMD, with lean mass explaining 12% of the variability in BMD. Taken together, these results suggest that it is crucial to track children with CD's lifestyle habits, including their diet and PA levels, to enhance their lean mass and, therefore, their bone health. In conclusion, adhering to a nutritionally adequate GFD with a healthy dietary profile, combined with vigorous PA, can positively affect body composition and bone health in children with CD. Given these findings, it is critical to promote these healthy habits in this population, highlighting the significance of further research in this area to better understand the underlying mechanisms and design effective interventions to improve bone health in children with CD.