Teker-Düztaş Demet, Özata-Uyar Gizem, Dalgiç Buket
Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Department of Nutrition and Dietetics, Faculty of Health Sciences, Kirikkale University, Kırıkkale, Turkey.
Nutrition. 2025 May 20;139:112851. doi: 10.1016/j.nut.2025.112851.
BACKGROUND: Celiac disease is a chronic autoimmune disorder of the small intestine for which the sole effective treatment is a lifelong gluten-free diet (GFD). Gluten immunogenic peptides (GIP) serve as biomarkers for recent gluten intake and can be utilized to assess gluten consumption levels. The aim of this study was to compare levels of fecal GIP with levels of tissue transglutaminase IgA (tTG-IgA), as well as dietary compliance, during follow-up. METHODS: This prospective, non-randomized, single-center study took place between August 2019 and August 2021 at Pediatric Gastroenterology Clinic at Gazi University Hospital in Ankara with the participation of 24 newly diagnosed celiac patients between 2 and 18 years (17 females, 7 males). Participants received GFD training from an expert dietitian, while any dietary transgressions were determined and assessed at 3 and 6 months. Levels of fecal GIP and blood tTG-IgA were analyzed at diagnosis, and again in follow-ups, using a sandwich enzyme-linked immunosorbent assay kit. Compliance with GFD was evaluated using a structured approach in terms of levels of GIP, tissue transglutaminase (tTG), Biagi score, as well as 24-hour food consumption records kept for 3 days (2 weekdays and 1 weekend). RESULTS: The mean age of participants was 8.3 ± 4.70 years. 23 patients (95.8%) initially had detectable GIP levels, while serum tTG-IgA was determined to be positive for all. After starting the GFD, GIP detection rates were measured as being 37.5% at 3 months, and 25% at 6 months, while tTG-IgA positivity rates were determined as being 41.7% and 37.5% respectively. While no significant correlation was found between GIP and tTG-IgA positivity. GIP detection at 3 months was moderately associated with dietitian assessments and Biagi scores (P < 0.05) but with no association at 6 months. CONCLUSIONS: Expert dietitian training with regular monitoring increases celiac disease patients complying with GFD. Repeated fecal GIP analysis demonstrated any dietary nonadherence or unintentional gluten exposure that had occurred during the previous 2 to 7 days. It is suggested that a combination of these two tools can improve assessment of dietary compliance in celiac patients.
背景：乳糜泻是一种小肠慢性自身免疫性疾病，唯一有效的治疗方法是终身无麸质饮食（GFD）。麸质免疫原性肽（GIP）可作为近期麸质摄入量的生物标志物，用于评估麸质摄入水平。本研究的目的是比较随访期间粪便GIP水平与组织转谷氨酰胺酶IgA（tTG-IgA）水平以及饮食依从性。 方法：这项前瞻性、非随机、单中心研究于2019年8月至2021年8月在安卡拉加齐大学医院儿科胃肠病诊所进行，24名年龄在2至18岁之间新诊断的乳糜泻患者（17名女性，7名男性）参与。参与者接受了专业营养师的GFD培训，同时在3个月和6个月时确定并评估任何饮食违规情况。使用夹心酶联免疫吸附测定试剂盒在诊断时以及随访时分析粪便GIP和血液tTG-IgA水平。根据GIP水平、组织转谷氨酰胺酶（tTG）、比亚吉评分以及连续3天（2个工作日和1个周末）记录的24小时食物摄入量，采用结构化方法评估GFD依从性。 结果：参与者的平均年龄为8.3±4.70岁。23名患者（95.8%）最初可检测到GIP水平，而所有患者血清tTG-IgA均呈阳性。开始GFD后，3个月时GIP检测率为37.5%，6个月时为25%，而tTG-IgA阳性率分别为41.7%和37.5%。虽然GIP与tTG-IgA阳性之间未发现显著相关性。3个月时的GIP检测与营养师评估和比亚吉评分中度相关（P<0.05），但6个月时无相关性。 结论：专业营养师培训并定期监测可提高乳糜泻患者对GFD的依从性。重复进行粪便GIP分析可显示过去2至7天内发生的任何饮食不依从或意外麸质暴露情况。建议将这两种工具结合使用可改善对乳糜泻患者饮食依从性的评估。
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