Department of Chemistry and Biodynamics of Food, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland.
Department of Pediatrics, Gastroenterology and Nutrition Collegium Medicum School of Medicine University of Warmia and Masuria, Żołnierska 18A Str., 10-561 Olsztyn, Poland.
Bone. 2019 May;122:184-192. doi: 10.1016/j.bone.2019.03.001. Epub 2019 Mar 3.
Bone metabolism disturbances are commonly observed in patients with newly diagnosed celiac disease (CD). The only available treatment for CD-the intake of a gluten-free diet (GFD)-has been found to be insufficient in effectively improving bone health in some patients. Therefore, there is an urgent need to modify the GFD so as to allow for the provision of all the necessary nutrients and improved absorption. Prebiotics intake reportedly improves the absorption of bone-related vitamin D and calcium as well as bone metabolism. The effect of prebiotic intake on bone health in CD patients has not been studied yet. This study aimed to evaluate the effect of oligofructose-enriched inulin intake on bone metabolism and immune response in children with CD on a GFD.
A total of 34 children with CD were randomised into two groups receiving 10 g of oligofructose-enriched inulin (Synergy 1) or a placebo (maltodextrin) for three months, together with a strict GFD. The children's bone metabolism marker levels and cytokine profiles were analysed before and after the intervention.
After supplementation, the concentration of osteocalcin increased significantly in children receiving Synergy 1, while the concentration of bone alkaline phosphatase increased in both groups, independent of supplementation. After the intervention, the level of pyridinoline increased significantly in the placebo group, resulting in a concentration that was two times higher than that in the Synergy 1 group, in which it remained stable. Moreover, the plasma concentrations of N-terminal telopeptides of type I collagen decreased in both the groups, whereas the tartrate-resistant acid phosphatase 5b level increased particularly in the Synergy 1 group. The intervention did not lead to immunological response changes.
The proposed supplementation beneficially altered bone metabolism, through increased bone formation rates and decreased bone resorption process rates. Supplementation of GFD with prebiotic oligofructose-enriched inulin may be a promising auxiliary therapy for bone metabolism improvements in children with CD.
新诊断的乳糜泻（CD）患者常出现骨代谢紊乱。CD 的唯一治疗方法——无麸质饮食（GFD）——已被发现不足以有效改善某些患者的骨骼健康。因此，迫切需要修改 GFD，以提供所有必要的营养物质并改善吸收。据报道，益生元的摄入可改善与骨骼相关的维生素 D 和钙的吸收以及骨代谢。益生元摄入对 CD 患者骨骼健康的影响尚未得到研究。本研究旨在评估富含低聚果糖的菊粉摄入对 GFD 治疗的 CD 患儿骨代谢和免疫反应的影响。
共有 34 名 CD 患儿被随机分为两组，分别服用 10g 富含低聚果糖的菊粉（Synergy 1）或安慰剂（麦芽糊精），持续 3 个月，同时接受严格的 GFD。在干预前后分析了儿童的骨代谢标志物水平和细胞因子谱。
补充后，接受 Synergy 1 治疗的儿童骨钙素浓度显著升高，而两组的碱性磷酸酶骨浓度均升高，与补充无关。干预后，安慰剂组的吡啶啉水平显著升高，使其浓度是 Synergy 1 组的两倍，而 Synergy 1 组的浓度保持稳定。此外，两组的 I 型胶原 N 端肽的血浆浓度均降低，而抗酒石酸酸性磷酸酶 5b 水平在 Synergy 1 组中特别升高。干预并未导致免疫反应变化。
该方案的补充通过增加成骨率和降低破骨率，有益地改变了骨代谢。在 GFD 中添加益生元低聚果糖菊粉可能是改善 CD 患儿骨骼代谢的一种有前途的辅助治疗方法。
