University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, Ljubljana, Slovenia.
Bone. 2010 Sep;47(3):598-603. doi: 10.1016/j.bone.2010.06.008. Epub 2010 Jun 19.
Low bone mineral density (BMD) is common in children and adolescents with celiac disease. Strict gluten-free diet (GFD) improves bone mineralization, even in 1 year. The effect of occasional gluten intake is not known. The aims of this study were to compare BMD and prevalence of low BMD in children and adolescents on strict and not strict GFD.
We measured BMD in 55 children and adolescents (strict GFD) with negative endomysium antibodies (EMA) in the last 2 years and in 19 (not strict GFD) with positive EMA at the time of the study. Lumbar, left hip and total body BMD were measured by dual-energy X-ray absorptiometry. Four-day weighted dietary protocols were obtained by means of a self-completed questionnaire of total food and beverage intake. Energy and calcium intake were calculated using nutrition data software. EMA, tissue transglutaminase antibodies, serum calcium, phosphate, 25-hydroxy vitamin D, intact parathormone, albumin, urea and creatinine levels were determined in all patients.
BMD in patients on strict GFD was significantly higher than in patients on not strict GFD (lumbar p=0.01; total body p=0.005). There were significantly more patients with total body BMD below -1.0 in not strictly compliant group (71% compared to 38%; p=0.03). Calcium intake and vitamin D levels were below recommendations in both groups.
Children and adolescents on not strict GFD are at increased risk for low BMD. We therefore recommend that BMD should be evaluated in patients with positive EMA. In addition, patients on strict GFD are at risk for low BMD because of low calcium intake or vitamin D deficiency. Therefore, strict GFD with recommended calcium intake and vitamin D supplementation during winter and spring should be encouraged in all children and adolescents with celiac disease.
乳糜泻患儿和青少年中普遍存在骨密度（BMD）低的情况。严格的无麸质饮食（GFD）可改善骨矿化，甚至在 1 年内即可起效。偶尔摄入麸质的影响尚不清楚。本研究旨在比较严格和不严格 GFD 患儿和青少年的 BMD 及低 BMD 患病率。
我们测量了 55 名过去 2 年内 EMA 阴性（严格 GFD）和 19 名 EMA 阳性（不严格 GFD）的患儿和青少年的 BMD。采用双能 X 射线吸收法测量腰椎、左侧髋部和全身 BMD。通过一份完整的食物和饮料摄入量自我完成问卷获得为期 4 天的加权膳食方案。使用营养数据软件计算能量和钙摄入量。在所有患者中均测定 EMA、组织转谷氨酰胺酶抗体、血清钙、磷、25-羟维生素 D、完整甲状旁腺激素、白蛋白、尿素和肌酐水平。
严格 GFD 患者的 BMD 明显高于不严格 GFD 患者（腰椎 p=0.01；全身 p=0.005）。不严格遵守组中有更多的患者全身 BMD 低于-1.0（71%比 38%；p=0.03）。两组的钙摄入量和维生素 D 水平均低于推荐值。
不严格遵循 GFD 的患儿和青少年发生低 BMD 的风险增加。因此，我们建议对 EMA 阳性的患者应评估 BMD。此外，由于钙摄入不足或维生素 D 缺乏，严格遵循 GFD 的患者也存在低 BMD 的风险。因此，应鼓励所有乳糜泻患儿和青少年在冬季和春季严格遵循 GFD，并补充推荐量的钙和维生素 D。
