Russell Lindsey A, Alliston Paige, Armstrong David, Verdu Elena F, Moayyedi Paul, Pinto-Sanchez Maria Ines
Farncombe Family Digestive Health Research Institute, Hamilton, ON L8S 4L8, Canada.
Division of Gastroenterology, McMaster University, Hamilton, ON L8S 4L8, Canada.
J Clin Med. 2025 Jul 8;14(14):4848. doi: 10.3390/jcm14144848.
A gluten-free diet (GFD) has been shown to be nutritionally inadequate for those with wheat-related disorders. However, the differences in findings and the absence of quantitative analysis limits the interpretation of previous reviews. We conducted a systematic review and meta-analysis to identify the risk of micronutrient deficiencies in patients with celiac disease (CeD) and non-celiac gluten or wheat sensitivity (NCWS). We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science (Ovid) databases. The risk of bias was determined using the ROBINS-1, and the quality of evidence was assessed using the GRADE approach. We identified 7940 studies; 46 observational studies (11 cohort, 9 cross-sectional, and 26 case-control) were eligible for analysis. CeD patients had an increased risk of vitamin D and E deficiencies compared with the non-CeD controls. CeD on a GFD had a decreased risk of vitamin D, B12, E, calcium, and iron deficiencies compared with untreated CeD. NCWS had an increased risk of vitamin B12, folate, and iron deficiency compared to the controls. The overall quality of evidence was rated very low. The risk of various micronutrient deficiencies is increased in CeD but is decreased for some after a GFD. Adequately powered studies with a rigorous methodology are needed to inform the risk of nutrient deficiencies in patients with CeD and NCWS. Protocol registration: Prospero-CRD42022313508.
对于患有与小麦相关疾病的人来说，无麸质饮食（GFD）已被证明在营养方面是不足的。然而，研究结果的差异以及缺乏定量分析限制了对以往综述的解读。我们进行了一项系统综述和荟萃分析，以确定乳糜泻（CeD）和非乳糜泻性麸质或小麦敏感（NCWS）患者中微量营养素缺乏的风险。我们检索了Cochrane对照试验中央注册库、MEDLINE、EMBASE和科学网（Ovid）数据库。使用ROBINS-1确定偏倚风险，并使用GRADE方法评估证据质量。我们识别出7940项研究；46项观察性研究（11项队列研究、9项横断面研究和26项病例对照研究）符合分析条件。与非CeD对照组相比，CeD患者维生素D和E缺乏的风险增加。与未经治疗的CeD相比，采用GFD的CeD患者维生素D、B12、E、钙和铁缺乏的风险降低。与对照组相比，NCWS患者维生素B12、叶酸和铁缺乏的风险增加。证据的总体质量被评为非常低。CeD患者各种微量营养素缺乏的风险增加，但在采用GFD后，某些微量营养素缺乏的风险会降低。需要有足够样本量且方法严谨的研究来了解CeD和NCWS患者营养缺乏的风险。方案注册：Prospero-CRD42022313508。
