Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.
Department of Pediatrics, Second University of Naples, Naples, Italy.
Acta Diabetol. 2017 Oct;54(10):889-894. doi: 10.1007/s00592-017-1019-5. Epub 2017 Jun 21.
Low HDL cholesterol (HDL-C) levels have been described in patients with coexisting type 1 diabetes mellitus (T1DM) and celiac disease (CD). Data on other possible lipid abnormalities that could further increase cardiovascular risk in these patients are scarce and incomplete. Aim of this retrospective multicenter study was to evaluate whole lipid profiles, besides HDL-C, in children with T1DM associated with biopsy-proven CD, and to investigate the influence of age and degree of adherence to gluten-free diet (GFD) on lipid changes.
A total of 261 children with both T1DM and CD were enrolled. Serum lipid profiles at CD diagnosis were compared with those after 1 year of GFD and with those of 224 matched children with T1DM alone. The adherence to GFD was judged by means of CD-related antibodies.
At CD diagnosis, children with T1DM + CD showed higher LDL cholesterol (LDL-C) compared to children with T1DM alone. Gluten withdrawal failed to normalize LDL-C levels, not even in completely adherent individuals. HbA1c values were not influenced by GFD. The youngest children were characterized at diagnosis by lower levels of total cholesterol and on treatment by a greater decrease in triglycerides levels.
An unfavorable lipid profile, characterized not only by low HDL-C levels but also by high LDL-C values, may increase the risk of cardiovascular disease in children with T1DM and untreated CD. Therefore, a strict gluten-free diet is mandatory in these children, especially the youngest.
合并 1 型糖尿病（T1DM）和乳糜泻（CD）的患者存在低高密度脂蛋白胆固醇（HDL-C）水平。关于其他可能进一步增加这些患者心血管风险的脂质异常的数据很少且不完整。本回顾性多中心研究的目的是评估 T1DM 合并经活检证实的 CD 患儿的全脂质谱，除 HDL-C 外，还评估年龄和对无麸质饮食（GFD）的依从程度对脂质变化的影响。
共纳入 261 例同时患有 T1DM 和 CD 的儿童。将 CD 诊断时的血清脂质谱与 GFD 治疗 1 年后的脂质谱以及 224 例单纯 T1DM 儿童的脂质谱进行比较。通过与 CD 相关的抗体来判断对 GFD 的依从性。
在 CD 诊断时，与单纯 T1DM 儿童相比，T1DM+CD 儿童的 LDL 胆固醇（LDL-C）更高。即使在完全依从的个体中，戒断麸质也未能使 LDL-C 水平正常化。GFD 对 HbA1c 值没有影响。最年轻的儿童在诊断时总胆固醇水平较低，治疗后甘油三酯水平下降幅度更大。
不良的脂质谱不仅表现为低 HDL-C 水平，还表现为高 LDL-C 值，可能会增加未经治疗的 CD 合并 T1DM 儿童患心血管疾病的风险。因此，这些儿童，尤其是年龄最小的儿童，必须严格遵循无麸质饮食。
