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

Disclosures

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

In This Article

Results

In the study period, we enrolled 101 consecutive adult patients with newly diagnosed CD; three patients were excluded, two due to type 1 diabetes (two patients) and one due to ongoing pregnancy (one patient). The analysis was therefore conducted on 98 patients with CD at the time of diagnosis and after 1 year of GFD. A time of diagnosis the endoscopic findings were: normal mucosa in 15 patients, micronodular pattern in 25 subjects, scalopped folds in 20 patients, mosaic pattern in 19 cases and absent folds in 19 patients. As regards with nutritional parameters different from MS sub-categories, anaemia was detected in 45 patients (45%), hypoalbuminemia in 31 subjects (31%) and hypocalcaemia in 16 cases (16%). Our main results are summarised in Table 1, Figures 1 and 2.

Figure 1.

Prevalence of MS at diagnosis and 1 year after starting GFD. The percentage of MS increased from 2% (2 of 98) to 29.5% (29 of 98).

Figure 2.

MS sub-categories (mean) at baseline and after 1 year of GFD: (a) Waist circumference (85 cm ± 11 vs. 88 cm ± 12); (b) Glycaemia (86 mg/dL ± 11 vs. 92 ± 11 mg/dL); (c) Triglycerides (89.2 ± 40 mg/dL vs. 92.8 ± 50 mg/dL); (d) HDL cholesterol (51.8 ± 14 mg/dL vs. 53.8 ± 14 mg/dL; (e) Systolic Pressure (113 ± 11 mmHg vs. 118 ± 13 mmHg); (f) Diastolic Pressure (75 ± 8 mmHg vs. 78 ± 9 mmHg).

At diagnosis, only two patients with CD (2%) met the criteria for diagnosis of MS while 29 patients (29.5%) did so after 1 year of GFD (P < 0.01; OR: 20) (Figures 1 and 2). With regard to MS sub-categories, 48 vs. 72 patients exceeded waist circumference cut-off (mean values 85 cm ± 11 vs. 88 cm ± 12; P < 0.01; OR: 2.8) at diagnosis and 1 year after GFD respectively (Figure 2).

Four patients were hypertensive at the time of diagnosis, while 18 had high blood pressure after 1 year on GFD (4% vs. 18% P < 0.01; OR: 4.5).

Indicators of glucose regulation also showed significant differences at diagnosis and follow-up: seven patients at diagnosis vs. 25 patients 1 year after starting GFD had blood glucose levels which exceeded the threshold (7% vs. 25%, P = 0.01; OR: 3.7). The mean glycaemic value after 1 year of GFD was 92 mg/dL vs. 86 mg/dL at diagnosis.

No significant difference was recorded in the lipid profile between the diagnosis and the follow-up time points. More specifically, at these time points 32 vs. 34 patients with CD had reduced levels of HDL cholesterol (P = 0.7) and 7 vs. 16 patients had high levels of triglycerides (P = 0.05) respectively.

Mean BMI increased significantly after 1 year of GFD (22.9 kg/m2 ± 4 vs. 24.1 kg/m2 ± 4; P = 0.01). With reference to BMI categories, at diagnosis 68 patients (69.3%) were categorised as normal, 10 (10.2%) as underweight, 12 (12.2%) as overweight and 8 (8.1%) as obese. After 1 year of GFD, 4 patients with CD (4%) were categorised as underweight, 60 (61.2%) as normal, 26 (26.5%) as overweight and 8 (8.1%) as obese. After exclusion of gluten from the diet, 22 patients had an increase in BMI class (22.4%), with BMI increasing by more than two points in 26 patients (26.5%) (Figure 3). When considering the main MS sub-categories in accordance with the gender, female subjects with CD showed a higher increase in waist circumference respect to the male group (86 cm vs. 93 cm; P < 0.01) and higher level of serum HDL (57 mg/dL vs. 46 mg/dL; P < 0.01); no differences were found about blood pressure, glycaemia and level of triglycerides.

Figure 3.

Comparison of prevalence of BMI class at CD diagnosis and after 1 year of GFD. BMI <18.5 kg/m2 (underweight): 10.2% (10 of 98) vs. 4% (4 of 98); BMI 18.5–24.9 kg/m2 (normal weight):69.3% (68 of 98) vs. 61.2% (60 of 98); BMI 25–29.9 kg/m2 (overweight):12.2% (12 of 98) vs. 26.5% (26 of 98); BMI ≥30 kg/m2 (obese): 8.1% (8 of 98) vs. 8.1% (8 of 98).

With regard to the ultrasonographic hepatic evaluation, of the total 98 patients included in the study, 18 (18%) showed HS on US at the time of CD diagnosis and 28 after 1 year of GFD (18% vs. 28.5%; P = 0.1). HS was graded as mild (grade 1) in 19 patients (67.8%), moderate (grade 2) in 6 patients (21.4%) and severe (grade 3) in 3 patients (10.7%) (grade 3). HS was present in 19 of the 29 patients with MS and in 9 of the 69 patients with CD without MS (65% vs. 13%; P < 0.01; OR: 19).

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