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维生素和矿物质缺乏症在新诊断的乳糜泻患者中极为普遍。

Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.

机构信息

Department of Nutrition and Dietetics, VU University Medical Centre, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.

出版信息

Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975.

Abstract

Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current "early diagnosed" untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B₆, B₁₂, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B₆ 14.5%, folic acid 20%, and vitamin B₁₂ 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B₁₂. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly "early diagnosed" CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.

摘要

吸收不良、体重减轻和维生素/矿物质缺乏是典型的乳糜泻(CD)的特征。本研究旨在评估荷兰目前未经治疗的新诊断成年 CD 患者的营养和维生素/矿物质状况。纳入了新诊断的成年 CD 患者(n = 80,42.8 ± 15.1 岁),并添加了 24 名健康荷兰受试者的可比样本以比较维生素浓度。测定了营养状况和叶酸、维生素 A、B₆、B₁₂ 和(25-羟)D、锌、血红蛋白(Hb)和铁蛋白的血清浓度(在开具无麸质饮食之前)。几乎所有 CD 患者(87%)至少有一种值低于参考下限。具体而言,7.5%的患者维生素 A 水平不足,14.5%的患者维生素 B₆ 不足,20%的患者叶酸不足,19%的患者维生素 B₁₂ 不足。同样,67%的 CD 患者存在锌缺乏,46%的患者铁储存减少,32%的患者贫血。总体而言,17%的患者存在营养不良(>10%的体重减轻),22%的女性体重不足(BMI < 18.5),29%的患者超重(BMI > 25)。维生素缺乏在健康对照组中几乎看不到,除了维生素 B₁₂。维生素/矿物质缺乏与(更高)程度的组织学肠道损伤或(受损)营养状况无关。结论是,即使在最初诊断时肥胖的患病率正在上升,新诊断的 CD 患者仍普遍存在维生素/矿物质缺乏。广泛的营养评估似乎是必要的,以指导 CD 治疗中的营养建议和随访。

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