Wierdsma Nicolette J, Nijeboer Petula, de van der Schueren Marian A E, Berkenpas Marijke, van Bodegraven Ad A, Mulder Chris J J
Department of Nutrition and Dietetics, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Gastroenterology, Celiac Centre Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
Clin Nutr. 2016 Jun;35(3):685-91. doi: 10.1016/j.clnu.2015.04.014. Epub 2015 Apr 30.
BACKGROUND & AIMS: Refractory celiac disease type II (RCDII) and EATL (Enteropathy Associated T-cell Lymphoma) are (pre)malignant complications of celiac disease (CD). Data on malnutrition and intestinal absorption is lacking in these patients. Therefore, the aim of the study is to comprehensively assess nutritional status and intestinal absorption capacity of patients with RCDII and EATL, compared with data of newly diagnosed CD patients.
Observational study in tertiary care setting in RCDII (n = 24, 63.8 ± 8.2 y), EATL (n = 25, 62.3 ± 5.7 y) and CD patients (n = 43, 45.6 ± 14.8 y). At diagnosis, anthropometry (BMI, unintentional weight loss, fat-free mass index (FFMI), handgrip strength (HGS), nutritional intake, fecal losses and Resting Energy Expenditure (REE)) were assessed.
Low BMI (<18.5) was more often observed in RCDII patients than in CD or EATL patients (in 33%, 12% and 12%, respectively, p = 0.029). EATL patients more frequently had unintentional weight loss (>10%) than CD or RCDII patients (in 58%, 19% and 39% of patients, respectively; p = 0.005/0.082). Energy malabsorption (<85%) was detected in 44% and 33% of RCDII and EATL patients, vs 21.6% in CD (NS). Fecal energy losses were higher in RCDII than in CD patients (589 ± 451 vs 277 ± 137 kcal/d, p = 0.017). REE was underestimated by predicted-REE with>10% in 60% of RCDII, 89% of EATL, and 38% of CD patients (p = 0.006). Low FFMI and HGS were detected in one third and two thirds of all patients, respectively.
The nutritional status of patients with RCDII and EATL is inferior compared with untreated naïve CD patients at presentation. Both malabsorption as well as hypermetabolism contribute to malnutrition.
II型难治性乳糜泻（RCDII）和肠病相关T细胞淋巴瘤（EATL）是乳糜泻（CD）的（前）恶性并发症。这些患者缺乏营养不良和肠道吸收方面的数据。因此，本研究的目的是全面评估RCDII和EATL患者的营养状况和肠道吸收能力，并与新诊断的CD患者的数据进行比较。
在三级医疗机构对RCDII患者（n = 24，63.8±8.2岁）、EATL患者（n = 25，62.3±5.7岁）和CD患者（n = 43，45.6±14.8岁）进行观察性研究。在诊断时，评估人体测量指标（体重指数、非故意体重减轻、去脂体重指数（FFMI）、握力（HGS））、营养摄入、粪便损失和静息能量消耗（REE）。
RCDII患者中低体重指数（<18.5）的发生率高于CD或EATL患者（分别为33%、12%和12%，p = 0.029）。EATL患者非故意体重减轻（>10%）的发生率高于CD或RCDII患者（分别为58%、19%和39%的患者；p = 0.005/0.082）。44%的RCDII患者和33%的EATL患者存在能量吸收不良（<85%），而CD患者中这一比例为21.6%（无统计学差异）。RCDII患者的粪便能量损失高于CD患者（589±451 vs 277±137千卡/天，p = 0.017）。60%的RCDII患者、89%的EATL患者和38%的CD患者的静息能量消耗被预测静息能量消耗低估>10%（p = 0.006）。所有患者中分别有三分之一和三分之二检测到低去脂体重指数和低握力。
与初诊时未经治疗的单纯CD患者相比，RCDII和EATL患者的营养状况较差。吸收不良和高代谢均导致营养不良。
