Dickey William, Kearney Natalie
Department of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom.
Am J Gastroenterol. 2006 Oct;101(10):2356-9. doi: 10.1111/j.1572-0241.2006.00750.x.
It is well established that a minority of celiac patients present with "classic" symptoms due to malabsorption. However, few studies have focussed on the distribution of body mass index (BMI) in celiac populations and its relationship to clinical characteristics, or on its response to treatment.
We reviewed BMI measurements and other clinical and pathological characteristics from a database of 371 celiac patients diagnosed over a 10-yr period and seen by a single gastroenterologist. To assess response to gluten exclusion, we compared BMI at diagnosis and after 2 yr treatment in patients with serological support for dietary compliance.
Mean BMI was 24.6 kg/m2 (range 16.3-43.5). Seventeen patients (5%) were underweight (BMI < 18.5), 211 (57%) were normal, and 143 (39%) were overweight (BMI > or = 25), including 48 (13% of all patients) in the obese range (BMI > or = 30.0). There was a significant association between low BMI and female gender, history of diarrhea, reduced hemoglobin concentration, reduced bone mineral density (BMD), osteoporosis, and higher grades (subtotal/total) of villous atrophy. Of patients compliant with a gluten-free diet, 81% had gained weight after 2 yr, including 82% of initially overweight patients.
Few celiac patients are underweight at diagnosis and a large minority is overweight; these are less likely to present with classical features of diarrhea and reduced hemoglobin. Failed or delayed diagnosis of celiac disease may reflect lack of awareness of this large subgroup. The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.
众所周知，少数乳糜泻患者会因吸收不良而出现“典型”症状。然而，很少有研究关注乳糜泻人群的体重指数（BMI）分布及其与临床特征的关系，或其对治疗的反应。
我们回顾了一个数据库中371例乳糜泻患者的BMI测量值以及其他临床和病理特征，这些患者是在10年期间由一位胃肠病专家诊断的。为了评估对无麸质饮食的反应，我们比较了血清学支持饮食依从性的患者在诊断时和治疗2年后的BMI。
平均BMI为24.6kg/m²（范围16.3 - 43.5）。17例患者（5%）体重过轻（BMI < 18.5），211例（57%）正常，143例（39%）超重（BMI ≥ 25），其中48例（占所有患者的13%）处于肥胖范围（BMI ≥ 30.0）。低BMI与女性性别、腹泻病史、血红蛋白浓度降低、骨密度（BMD）降低、骨质疏松以及绒毛萎缩的更高等级（部分/全部）之间存在显著关联。在遵循无麸质饮食的患者中，81%在2年后体重增加，其中包括82%最初超重的患者。
很少有乳糜泻患者在诊断时体重过轻，而很大一部分患者超重；这些患者不太可能出现腹泻和血红蛋白降低的典型特征。乳糜泻疾病的诊断失败或延迟可能反映出对这一庞大亚组缺乏认识。饮食中排除麸质后，原本超重患者体重增加是发病的一个潜在原因，因此常规规定的无麸质饮食需要相应调整。
