Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

McGrogan, L. et al. (2021) Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet. Clinical Nutrition, 40(5), pp. 2784-2790. (doi: 10.1016/j.clnu.2021.03.006) (PMID:33933744)

Abstract

Introduction: In coeliac disease (CD) micronutrient deficiencies may occur due to malabsorption in active disease and diminished intake during treatment with a gluten-free diet (GFD). This study assessed the micronutrient status in children with CD at diagnosis and follow-up. Methods: Fifteen micronutrients were analysed in 106 blood samples from newly diagnosed CD and from patients on a GFD for <6 months, 6-12 months and with longstanding disease (>12 months). Predictors of micronutrient status included: demographics, disease duration, anthropometry, gastrointestinal symptoms, raised tissue transglutaminase antibodies (TGA), multivitamin use and faecal gluten immunogenic peptide (GIP). Micronutrient levels were compared against laboratory reference values. Results: At CD diagnosis (n=25), low levels in ≥10% of patients were observed for: vitamins E (88%), B1 (71%), D (24%), K (21%), A (20%) and B6 (12%), ferritin (79%), and zinc (33%). One year post-diagnosis, repletion of vitamins E, K, B6 and B1 was observed (<10% patients). In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis. Copper, selenium and magnesium did not differ significantly between diagnosis and follow-up. All samples for B2, folate, vitamin C (except for one sample) and B12 were normal. A raised TGA at follow-up was associated with low vitamins A and B1 (raised vs normal TGA; vitamin A: 40% vs 17%, p=0.044, vitamin B1: 37% vs 13%, p=0.028). Low vitamin A (p=0.009) and vitamin D (p=0.001) were more common in samples collected during winter. There were no associations between micronutrient status with GIP, body mass index, height, socioeconomic status, or gastrointestinal symptom. Multivitamin use was less common in patients with low vitamin D. Conclusions: Several micronutrient deficiencies in CD respond to a GFD but others need to be monitored long-term and supplemented where indicated.

• Item Type: Articles
• Additional Information: This study was funded by a competitive grant from Nutricia Research Foundation and The University of Glasgow. RH and RKR are supported by NHS Research Scotland Career Researcher Clinician awards.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Russell, Dr Richard and Mackinder-Jonas, Mary and Gerasimidis, Professor Konstantinos and AROUTIOUNOVA, Miss MARIA and Edwards, Professor Christine and Hansen, Dr Richard
• Authors: McGrogan, L., Mackinder, M., Stefanowicz, F., Aroutiounova, M., Catchpole, A., Wadsworth, J., Buchanan, E., Cardigan, T., Duncan, H., Hansen, R., Russell, R. K., Edwards, C. A., Talwar, D., McGrogan, P., and Gerasimidis, K.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Clinical Nutrition
• Publisher: Elsevier
• ISSN: 0261-5614
• ISSN (Online): 1532-1983
• Published Online: 16 March 2021
• Copyright Holders: Copyright © 2021 Elsevier Ltd. and European Society for Clinical Nutrition and Metabolism
• First Published: First published in Clinical Nutrition 40(5): 2784-2790
• Publisher Policy: Reproduced in accordance with the publisher copyright policy