Metabolic Syndrome in Patients With Coeliac Disease on a Gluten-free Diet

R. Tortora; P. Capone; G. De Stefano; N. Imperatore; N. Gerbino; S. Donetto; V. Monaco; N. Caporaso; A. Rispo


Aliment Pharmacol Ther. 2015;41(4):352-359. 

In This Article

Abstract and Introduction


Background Several studies have shown that weight changes are common in patients with coeliac disease after starting a gluten-free diet (GFD), but data on the prevalence of metabolic syndrome in this population are still scarce.

Aims To assess the prevalence of metabolic syndrome in patients with CD at diagnosis and 1 year after starting GFD.

Methods We enrolled all consecutive patients with newly diagnosed coeliac disease (CD) who were referred to our third-level CD Unit. For all patients we collected: waist circumference, BMI, blood pressure, lipid profile (HDL cholesterol, triglycerides) and levels of blood glucose. Diagnosis of metabolic syndrome was made according to the International Diabetes Federation (IDF) criteria for European countries. The prevalence of metabolic syndrome was re-assessed after 12 months of GFD.

Results Ninety-eight patients with CD were assessed, two patients with CD (2%) fulfilled the diagnostic criteria for metabolic syndrome at diagnosis and 29 patients (29.5%) after 12 months of GFD (P < 0.01; OR: 20). With regard to metabolic syndrome sub-categories 1 year after GFD compared to baseline respectively: 72 vs. 48 patients exceeded waist circumference cut-off (P < 0.01; OR: 2.8); 18 vs. 4 patients had high blood pressure (P < 0.01; OR: 5.2); 25 vs. 7 patients exceeded glycemic threshold (P = 0.01; OR: 4.4); 34 vs. 32 patients with CD had reduced levels of HDL cholesterol (P = 0.7); and 16 vs. 7 patients had high levels of triglycerides (P = 0.05).

Conclusions Patients with coeliac disease show a high risk of metabolic syndrome 1 year after starting a gluten-free diet. We suggest that an in-depth nutritional assessment is undertaken for all patients with coeliac disease.


Coeliac disease (CD) is a chronic autoimmune disorder characterised by the involvement of the small bowel and triggered by the ingestion of gluten-containing foods in genetically pre-disposed individuals.[1,2] The prevalence of CD worldwide ranges between one in 100 individuals and one in 300 individuals in the general population.[3,4] In recent years, the clinical presentation of CD has changed with typical symptoms such as diarrhoea and weight loss having become less frequent especially in adult patients,[1,5] who are more frequently overweight or obese than underweight at diagnosis.[6] In accordance with the most recent guidelines, a diagnosis of CD is made when CD specific autoantibodies – anti-tissue transglutaminase (a-tTG) and anti-endomysial antibodies (EMA) – are detected, in the presence of positive duodenal histology.[7–9] At present, the only treatment for CD is a strict gluten-free diet (GFD).

Several studies have shown that weight changes are common in patients with CD after the adoption of GFD. However, although some evidence concerning changes in Body Mass Index (BMI) is reported in the scientific literature,[10–12] data on the prevalence of metabolic syndrome (MS) and hepatic steatosis (HS) in patients with CD on free diet and on GFD are still scarce.

MS is defined as a cluster of metabolically related risk factors for cardiovascular disease and type 2 diabetes (abdominal obesity, high blood pressure, dyslipidaemia and impaired glucose regulation).[13] The prevalence of MS is estimated to be approximately 20–25% among the world's adult population,[14] although epidemiological data mainly depend on the diagnostic criteria used for its diagnosis.[15,16]

In 1998, the World Health Organization (WHO)[17] proposed the first set of criteria for diagnosis of MS, which included the demonstration of insulin resistance as an essential element. Subsequently, in 2001, the National Cholesterol Education Programme's Adult Treatment Panel III (ATP III) formulated a new definition of MS,[18] without any mandatory criteria for diagnosis. Finally, with the aim of creating a more useful diagnostic tool for clinical practice, the International Diabetes Federation (IDF) modified the ATP III criteria, making central obesity (defined on the basis of ethnicity-sensitive waist circumference measurements) a prerequisite risk factor for the diagnosis of MS.[19] Hepatic steatosis and nonalcoholic fatty liver disease (NAFLD) are considered to be one of the possible hepatic expressions of MS.[20]

On the basis of these considerations, we planned a study to assess the prevalence of MS in patients suffering from CD both at the time of diagnosis and after 1 year of GFD. A secondary aim of the study was to assess the prevalence of HS in patients with CD at diagnosis and 1 year after starting GFD.