Italian Federation of Family Pediatricians (FIMP), Department of Continuing Medical Education, Area Lombardia, Italy.
Nutr Metab Cardiovasc Dis. 2013 Mar;23(3):177-82. doi: 10.1016/j.numecd.2011.10.002. Epub 2011 Dec 30.
Studies of adults and children with celiac disease (CD) performed mostly in tertiary care centers have reported an increased risk of overweight during gluten-free diet (GFD). We measured body mass index (BMI) of CD children followed by family pediatricians in order to estimate prevalence of underweight and overweight at diagnosis and to describe BMI changes during GFD.
We compared 150 CD children (age range 2-16 yrs) under GFD from a median (IQR) time of 4.4 (4.2) years with 288 healthy children matched for gender and age. We also evaluated retrospectively BMI changes between CD diagnosis and the current evaluation. The median (IQR) BMI of CD patients was significantly lower than that of controls [-0.38 (1.46) vs. 0.09 (1.18) SDS, p < 0.0001, Italian reference data]. Using the International Obesity Task Force classifications, CD children were less frequently overweight or obese (12% vs. 23.3%, p = 0.014) and more frequently underweight (16% vs. 4.5%, p < 0.001) than controls. During GFD, there was a marked decrease of number of underweight subjects (13 vs. 27) and a minimal increase of number of overweight subjects (9 vs. 6) (p < 0.001).
The frequency of overweight and obesity at diagnosis of CD and during GFD in children followed by family pediatricians is substantially lower than that reported in tertiary care centers. On the other hand, the high frequency of underweight at diagnosis confirms the need of careful personalized nutritional management.
成人和儿童乳糜泻（CD）的研究主要在三级医疗中心进行，报告称在无麸质饮食（GFD）期间超重的风险增加。我们测量了由家庭儿科医生随访的 CD 儿童的体重指数（BMI），以估计诊断时体重不足和超重的患病率，并描述 GFD 期间 BMI 的变化。
我们比较了 150 名处于 GFD 下（中位数[IQR]时间为 4.4[4.2]年）的 CD 儿童（年龄范围 2-16 岁）与 288 名性别和年龄匹配的健康儿童。我们还回顾性评估了 CD 诊断与当前评估之间 BMI 的变化。CD 患者的中位数（IQR）BMI 明显低于对照组[-0.38（1.46）与 0.09（1.18）SDS，p <0.0001，意大利参考数据]。使用国际肥胖工作组的分类，CD 儿童超重或肥胖的比例较低（12%比 23.3%，p = 0.014），消瘦的比例较高（16%比 4.5%，p <0.001）。在 GFD 期间，消瘦的人数明显减少（13 比 27），超重的人数略有增加（9 比 6）（p <0.001）。
由家庭儿科医生随访的 CD 儿童在诊断时和 GFD 期间超重和肥胖的频率明显低于三级医疗中心报告的频率。另一方面，消瘦的高频率在诊断时证实了需要进行仔细的个性化营养管理。
