Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
John Hunter Hospital, Newcastle, New South Wales, Australia.
J Gastroenterol Hepatol. 2018 Apr;33(4):781-791. doi: 10.1111/jgh.14039. Epub 2018 Feb 14.
A gluten-free diet (GFD), the mainstay of treatment for celiac disease, is being increasingly adopted by people without this condition. The long-term health effects of this diet, apart from its beneficial effect on enteropathy in celiac disease, are unclear. Concerns exist that the GFD may result in micronutrient deficiencies, increased exposure to toxins such as arsenic, and an increased cardiovascular risk. This systematic review addresses the effect of the GFD on several modifiable cardiovascular risk factors.
A systematic search of the literature addressing the GFD and blood pressure, glycaemia, body mass index, waist circumference, and serum lipids in patients before and after adoption of a GFD was conducted using the MEDLINE, EMBASE, PSYCInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. Two authors performed abstract and full text screening, and quality assessment.
A total of 5372 articles were identified, from which 27 were included. Lack of control groups in all but one study prevented meta-analysis of results. Overall study quality was low and restricted to patients with celiac disease. Consistent findings across studies included an increase in total cholesterol, high density lipoprotein, fasting glycaemia, and body mass index (while remaining within the healthy weight range). Significant changes in low density lipoprotein, triglycerides, and blood pressure were not consistently reported.
A GFD alters certain cardiovascular risk factors in patients with celiac disease, but the overall effect on cardiovascular risk is unclear. Further studies are warranted.
无麸质饮食（GFD）是治疗乳糜泻的主要方法，越来越多的非乳糜泻患者也开始采用这种饮食。除了对乳糜泻肠病有益外，这种饮食的长期健康影响尚不清楚。人们担心 GF D 可能导致微量营养素缺乏、增加砷等毒素暴露以及心血管风险增加。本系统评价旨在探讨 GF D 对几种可改变的心血管危险因素的影响。
使用 MEDLINE、EMBASE、PSYCInfo 和 Cochrane 对照试验中心注册库（CENTRAL）数据库，对涉及 GF D 和血压、血糖、体重指数、腰围和血清脂质的文献进行系统检索，检索内容为患者采用 GF D 前后的相关数据。两位作者进行了摘要和全文筛选，并进行了质量评估。
共确定了 5372 篇文章，其中 27 篇被纳入。除了一项研究外，所有研究均缺乏对照组，这使得结果无法进行荟萃分析。整体研究质量较低，仅限于乳糜泻患者。研究结果一致表明，总胆固醇、高密度脂蛋白、空腹血糖和体重指数（虽然仍在健康体重范围内）增加。低密度脂蛋白、甘油三酯和血压的显著变化并未得到一致报告。
GFD 改变了乳糜泻患者的某些心血管危险因素，但对心血管风险的总体影响尚不清楚。需要进一步研究。
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