Department of Systems Medicine, University of Rome 'Tor Vergata' , 00133 Rome , Italy.
Ann Med. 2013 Dec;45(8):522-31. doi: 10.3109/07853890.2013.849383. Epub 2013 Nov 7.
Reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium are common in untreated celiac disease (CD) patients probably due to loss of brush border proteins and enzymes needed for the absorption of these nutrients. In the majority of patients, removal of gluten from the diet leads to histological recovery and normalization of iron, vitamin, and mineral levels. Iron deficiency anemia is the most common extra-intestinal sign of CD and usually resolves with adherence to a gluten-free diet. However, deficiencies of both folate and vitamin B12 may persist in some patients on a gluten-free diet, thus requiring vitamin supplementation to improve subjective health status. Similarly, exclusion of gluten from the diet does not always normalize bone mineral density; in these cases, supplementation of vitamin D and calcium is recommended. Resolution of mucosal inflammation may not be sufficient to abrogate magnesium deficiency. Since gluten-free cereal products have a lower magnesium content as compared with gluten-containing counterparts, a magnesium-enriched diet should be encouraged in CD patients. In this article we discuss the frequency and clinical relevance of nutrient deficiency in CD and whether and when nutrient supplementation is needed.
未经治疗的乳糜泻(CD)患者体内铁、叶酸、维生素 B12、维生素 D、锌和镁的水平通常较低,这可能是由于吸收这些营养素所需的刷状缘蛋白和酶的丢失。在大多数患者中,从饮食中去除麸质可导致组织学恢复和铁、维生素和矿物质水平正常化。缺铁性贫血是 CD 的最常见的肠道外表现,通常随着无麸质饮食的坚持而得到解决。然而,在一些坚持无麸质饮食的患者中,叶酸和维生素 B12 的缺乏可能仍然存在,因此需要补充维生素以改善主观健康状况。同样,从饮食中排除麸质并不总是能使骨矿物质密度正常化;在这些情况下,建议补充维生素 D 和钙。黏膜炎症的消退可能不足以消除镁缺乏。由于无麸质谷物产品的镁含量低于含麸质产品,因此应鼓励 CD 患者食用富含镁的饮食。在本文中,我们讨论了 CD 患者营养素缺乏的频率和临床相关性,以及是否需要以及何时需要补充营养素。