Department of Nutrition and Dietetics, VU University Medical Centre, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.
Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975.
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.
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。