Peleg Noam, Niv Yaron, Dickman Ram, Boltin Doron, Krauthammer Alex, Herman-Edelstein Michal, Issa Nidal, Ollech Jacob E, Konikoff Tom, Gingold-Belfer Rachel
The Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital.
School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv.
J Clin Gastroenterol. 2024;58(10):989-997. doi: 10.1097/MCG.0000000000001998. Epub 2024 Mar 27.
Gluten-free diet (GFD) includes a higher intake of sugars and fats. Previous studies have investigated its effect on body mass index (BMI) in celiac disease (CD) patients but had contradictive conclusions. Thus, we conducted a systematic review and meta-analysis examining the effect of GFD on BMI in CD patients.
Systematically, we conducted literature research using Medline, Scopus, and Embase, and we identified 1565 potential studies/abstracts. Only studies of patients with CD under a GFD with recorded BMI before and after dietary intervention were included. Subgroup analyses based on study design and BMI categories were performed. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (Cls) for the number of patients in each BMI group according to the World Health Organization (WHO) definitions after GFD using fixed and random effect meta-analysis.
The analysis included 10 studies and 38 sub-studies/data sets, which encompassed 2450 patients from 5 countries. We found nonsignificant odds for changing the BMI group (pooled OR 0.972, 95% CI: 0.858-1.101, P =0.65) after GFD. However, looking specifically at BMI subgroups, we found higher odds for BMI category change after GFD in underweight patients (OR 0.588, 95% CI: 0.479-0.723, P <0.001), and overweight patients,25<BMI<30, (OR 1.332, 95% CI: 1.167-1.521, P <0.001). No publication bias was demonstrated, and the amount of heterogeneity between studies was moderate ( I2 =54.13).
Although crucial in patients with CD, GFD is associated with increased BMI in some CD patient populations. Accordingly, special considerations and follow-up should be maintained in overweight patients with CD after GFD.
无麸质饮食（GFD）包含更高的糖和脂肪摄入量。既往研究已调查其对乳糜泻（CD）患者体重指数（BMI）的影响，但得出了相互矛盾的结论。因此，我们进行了一项系统评价和荟萃分析，以研究GFD对CD患者BMI的影响。
我们系统地使用Medline、Scopus和Embase进行文献检索，共识别出1565项潜在研究/摘要。仅纳入了接受GFD饮食干预前后记录有BMI的CD患者研究。根据研究设计和BMI类别进行亚组分析。我们使用固定效应和随机效应荟萃分析，根据世界卫生组织（WHO）定义计算了GFD后各BMI组患者数量的合并比值比（OR）和95%置信区间（CI）。
该分析纳入了10项研究和38项子研究/数据集，涵盖来自5个国家的2450名患者。我们发现GFD后BMI组改变的比值无统计学意义（合并OR 0.972，95%CI：0.858 - 1.101，P = 0.65）。然而，具体查看BMI亚组时，我们发现体重过轻患者（OR 0.588，95%CI：0.479 - 0.723，P < 0.001）和超重患者（25 < BMI < 30，OR 1.332，95%CI：1.167 - 1.521，P < 0.001）在GFD后BMI类别改变的比值更高。未显示发表偏倚，研究间的异质性程度为中度（I² = 54.13）。
尽管GFD对CD患者至关重要，但在某些CD患者群体中与BMI升高有关。因此，对于CD超重患者在GFD后应给予特殊考虑和随访。
