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

Materials and Methods

Between July 2012 and July 2013, we carried out an observational prospective study including all consecutive adult patients with CD (>18 years) who were diagnosed at our Gastrointestinal Unit (tertiary centre for food intolerance and CD). CD diagnosis was made in the presence of Marsh ≥2 histology associated with both a-tTG IgA >7 U/mL and positive EMA.[1] Furthermore, the macroscopic findings at upper endoscopy were also recorded and classified in accordance with current literature.[21] All subjects with positive serology but negative histology (Marsh 0 or 1) underwent further investigations for genetic susceptibility and were diagnosed as 'potential' CD in the presence of HLA DQ2/DQ8.

All patients with CD underwent the following measurements and investigations: waist circumference (cm), blood pressure (mmHg), blood HDL cholesterol (mg/dL), blood triglycerides (mg/dL), blood glucose (mg/dL), blood levels of aspartate (AST, U/L) and alanine aminotransferase (ALT, U/L) and HS. With regard to blood pressure measurement, it was assessed 'in office' according to the ESH/ESC Guidelines.[22]

In accordance with the IDF criteria for European countries,[21] diagnosis of MS was made when waist circumference was ≥94 cm (male patients) or ≥80 cm (female patients) and two of the following risk factors were present: blood pressure ≥130/85 (or on anti-hypertensive treatment); HDL cholesterol <40 mg/dL (male patients) or <50 (female patients) (or on specific treatment); glucose ≥100 mg/dL (or previously diagnosed type 2 diabetes); triglycerides ≥150 mg/dL (or on specific treatment). In accordance with the WHO STEPS protocol, waist circumference measurement was made at the approximate mid-point between the lower margin of the last palpable rib and the top of the iliac crest.[23] All the serological evaluations were performed in the morning hours in the fasting state.

Furthermore, the BMI (body weight in kg/height in m2) of all patients was recorded and on the basis of its value patients were classified – in line with WHO criteria[24] – as underweight (BMI <18.5 kg/m2), normal (BMI between 18.5–24.9 kg/m2), overweight (BMI between 25–29.9 kg/m2) or obese (BMI ≥30 kg/m2). BMI values at diagnosis were compared with those after 1 year of GFD, and any change in BMI of 2 or more points was recorded as a clinically significant weight change. The prevalence of MS and the features of its sub-categories were assessed at diagnosis and after 1 year of GFD.

Hepatic steatosis was diagnosed noninvasively by abdominal ultrasonography (US). The ultrasonographic procedure was performed at diagnosis and after 1 year of GFD by using a 3.5–5 MHz multi-frequency transducer (Logiq 7 Pro, GE Medical System, Milan, Italy). Ultrasound examination was performed by an expert operator (A.R.) with a wide expertise (>3000 examinations) in abdominal/hepatic US. HS was diagnosed and graded in accordance with previously reported criteria: grade 1 (liver attenuation slightly inferior to that of spleen); grade 2 (more pronounced difference between liver and spleen and intrahepatic vessels not seen or slightly higher attenuation than liver); grade 3 (markedly reduced liver attenuation with a sharp contrast between liver and intrahepatic vessels).[25,26]

Adherence to GFD was assessed by measuring anti-tissue transglutaminase antibodies levels 6 and 12 months after starting GFD.[27] The dietary advice was provided by a departmental dietitian (V.M.) with a patient-tailored approach (even including heart healthy information).


Statistical analysis included use of χ2, Mann–Whitney U-test and Wilcoxon signed-rank test, when indicated. The odd ratio (OR) for quantifying the statistical difference between the dichotomous variables was also calculated. All differences were considered significant in presence of P < 0.05. The analysis was performed using spss software, version 14.0 (SPSS Inc, Chicago IL, USA).