National Institute of Diabetes and Digestive and Kidney Diseases, Democracy 2, Room 6009, 6707 Democracy Boulevard, Bethesda, MD, 20892-5458, USA.
Social and Scientific Systems, Inc, Silver Spring, MD, USA.
Sci Rep. 2022 Apr 2;12(1):5566. doi: 10.1038/s41598-022-09346-y.
Persons with celiac disease (CD) may develop nutritional deficiencies, while individuals following a gluten-free diet (GFD) may lack essential nutrients. We examined nutrient intake from diet and supplements among persons with CD and GFD in the cross-sectional National Health and Nutrition Examination Survey, 2009-2014. Among 15,610 participants 20 years and older, we identified CD based on positive serology for immunoglobulin A against tissue transglutaminase, health care provider diagnosis, and adherence to a GFD. People without CD avoiding gluten (PWAG) adhered to a GFD without a diagnosis of CD. Two 24-h recalls assessed nutrient intake from diet and supplements. Compared to participants without CD or PWAG, persons with diagnosed CD had lower intake of total energy, carbohydrates, fat, and saturated and monounsaturated fatty acids. In contrast, persons with undiagnosed CD and positive serology had higher intake of those nutrients, sugar, and protein. Total carbohydrate and sugar intake was lower among PWAG. Persons with diagnosed CD had higher vitamin A and E intake, while those with undiagnosed CD had increased intake of calcium, phosphorus, magnesium, iron, zinc, copper, sodium, potassium, vitamin A, alpha-carotene, folic acid, and choline. Higher micronutrient intake with undiagnosed CD was observed more at high latitudes. PWAG had higher beta-carotene and lutein/zeaxanthin and lower folic acid intake. In the U.S. population over a 6-year period, total energy and macronutrient intake was decreased among persons with diagnosed CD, while intake of total energy, macronutrients, and multiple micronutrients was increased among persons with undiagnosed CD. Nutriomics studies of multiple analytes measured simultaneously across affected persons and populations are needed to inform screening for malabsorption and treatment strategies.
乳糜泻患者可能会出现营养缺乏，而遵循无麸质饮食（GFD）的个体可能会缺乏必需营养素。我们在 2009-2014 年的全国健康和营养调查（NHANES）中，检查了乳糜泻患者和 GFD 个体的饮食和补充剂中的营养素摄入。在 15610 名 20 岁及以上的参与者中，我们根据针对组织转谷氨酰胺酶的免疫球蛋白 A 的阳性血清学、医疗保健提供者的诊断和对 GFD 的遵守情况确定了乳糜泻。无乳糜泻但避免食用麸质的人（PWAG）遵循 GFD 但没有乳糜泻的诊断。两次 24 小时回忆评估了饮食和补充剂中营养素的摄入量。与无 CD 或 PWAG 的参与者相比，诊断为 CD 的患者总能量、碳水化合物、脂肪和饱和及单不饱和脂肪酸的摄入量较低。相比之下，未经诊断的 CD 患者和阳性血清学患者的这些营养素、糖和蛋白质的摄入量较高。PWAG 的总碳水化合物和糖摄入量较低。诊断为 CD 的患者的维生素 A 和 E 摄入量较高，而未诊断的 CD 患者的钙、磷、镁、铁、锌、铜、钠、钾、维生素 A、α-胡萝卜素、叶酸和胆碱摄入量增加。在高纬度地区，未诊断的 CD 患者的微量营养素摄入增加更为明显。PWAG 的β-胡萝卜素和叶黄素/玉米黄质摄入量较高，叶酸摄入量较低。在美国人口中，在过去的 6 年中，诊断为 CD 的患者的总能量和宏量营养素摄入量减少，而未诊断的 CD 患者的总能量、宏量营养素和多种微量营养素的摄入量增加。需要对受影响的个体和人群进行同时测量多种分析物的营养组学研究，以告知吸收不良的筛查和治疗策略。
