are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro," Bari, Italy.
are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari "Aldo Moro," Bari, Italy.
Nutr Rev. 2023 Feb 10;81(3):252-266. doi: 10.1093/nutrit/nuac052.
Obesity is a significant risk factor for many pathological conditions. Whether a gluten-free diet (GFD) is a risk factor for overweight or obesity remains controversial.
The primary aim of this study was to assess the prevalence of body mass index (BMI) categories at disease presentation and the variation in BMI category from underweight/normal to overweight/obese and vice versa during a GFD.
PubMed, Scopus, and Web of Science databases were searched through February 2021 for retrospective, cross-sectional, and prospective studies reporting BMI categories at disease diagnosis and during a GFD.
Data were extracted by 2 reviewers independently. Disagreements were resolved by consensus; a third reviewer was consulted, if necessary. Risk of bias was assessed with the Cochrane ROBINS-I tool.
Subgroup analysis based on age (pediatric/adult patients), study design (prospective, cross-sectional, retrospective), and duration of GFD was performed.. Forty-five studies were selected (7959 patients with celiac disease and 20 524 healthy controls). The mean BMI of celiac patients at presentation was significantly lower than that of controls (P < 0.001). During a GFD, the mean BMI increased significantly (mean difference = 1.14 kg/m2 [95%CI, 0.68-1.60 kg/m2]; I2 = 82.8%; P < 0.001), but only 9% of patients (95%CI, 7%-12%; I2 = 80.0%) changed from the underweight/normal BMI category to the overweight/obese category, while 20% (95%CI, 11%-29%; I2 = 85.8%) moved into a lower BMI category.
Most celiac patients had a normal BMI at presentation, although the mean BMI was significantly lower than that of controls. A GFD does not increase the risk of becoming overweight/obese, especially in children. The quality of several studies was suboptimal, with moderate or high overall risk of bias and heterogeneity.
肥胖是许多病理状况的重要危险因素。无麸质饮食（GFD）是否是超重或肥胖的危险因素仍存在争议。
本研究的主要目的是评估疾病发病时体重指数（BMI）类别以及在 GFD 期间从体重不足/正常到超重/肥胖和反之的 BMI 类别变化的发生率。
通过 2021 年 2 月的 PubMed、Scopus 和 Web of Science 数据库检索回顾性、横断面和前瞻性研究，报告疾病诊断时和 GFD 期间的 BMI 类别。
由 2 名审查员独立提取数据。意见分歧通过共识解决；必要时咨询第 3 名审查员。使用 Cochrane ROBINS-I 工具评估偏倚风险。
基于年龄（儿科/成年患者）、研究设计（前瞻性、横断面、回顾性）和 GFD 持续时间进行亚组分析。共选择了 45 项研究（7959 例乳糜泻患者和 20524 例健康对照）。乳糜泻患者就诊时的平均 BMI 明显低于对照组（P<0.001）。在 GFD 期间，平均 BMI 显著增加（平均差异=1.14 kg/m2[95%CI，0.68-1.60 kg/m2]；I2=82.8%；P<0.001），但只有 9%的患者（95%CI，7%-12%；I2=80.0%）从体重不足/正常 BMI 类别转变为超重/肥胖类别，而 20%（95%CI，11%-29%；I2=85.8%）进入较低的 BMI 类别。
大多数乳糜泻患者就诊时的 BMI 正常，尽管平均 BMI 明显低于对照组。GFD 不会增加超重/肥胖的风险，尤其是在儿童中。几项研究的质量欠佳，总体存在中度或高度偏倚和异质性风险。
