Impact of compliance to a gluten-free diet on vitamin and trace element deficiencies in celiac patients

Main Article Content

Hasret Ayyildiz Civan


Background. Celiac disease (CD) is a chronic immune-mediated disorder characterized by growth retardation and malabsorbtion related to mucosal damage and inflammation of small intestine in genetically predisposed people as a result of gluten exposure. In CD treatment, clinical, histological and serological improvement is possible with gluten-free diet. Thus, we aimed to assess the vitamin and trace element levels of CD patients in regard to their compliance with gluten-free diet. Materials and methods. In our study, 77 patients diagnosed with CD were evaluated retrospectively. All individuals were assessed with Marsh classification histopathologically and surveyed when they follow a gluten-free diet. Demographic features, age of disease onset, physical examination findings, anthropometric measurements and laboratory findings along with clinical and laboratory outcomes of patients after a gluten-free diet were compared between compliant to diet and non-compliant to diet groups. Results. A total of 77 individuals, 48 females and 29 males with a diagnosis of CD and mean age of 9.81 ± 4.73 years on admission, were reqruited in our study. Patients were mostly found to have Marsh type 3a (n = 22) and Marsh type 3b (n = 20) histopathologically. The results of serological screening revealed that 40.3 % of people (n = 31) were compliant with diet whereas 59.7 % (n = 46) — non-compliant. Non-compliant group had significantly lower mean vitamin B12, vitamin D, folate, zinc and selenium levels compared to compliant group (p = 0.000; 0.000; 0.000; 0.000 and 0.031, respectively). In addition, a significantly higher mean serum total IgA level was detected in non-compliant group in comparison to compliant group (p = 0.027). Conclusions. High efficacy of gluten-free diet in correcting nutritional insufficiencies and deficiencies was shown. Thus, there is no doubt that informing patients and their families about lifelong gluten-free diet in detail is beneficial although this treatment contains many social and practical difficulties.

Article Details

How to Cite
Civan, H. A. “Impact of Compliance to a Gluten-Free Diet on Vitamin and Trace Element Deficiencies in Celiac Patients”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 16, no. 4, May 2020, pp. 300-4, doi:10.22141/2224-0721.16.4.2020.208481.
Original Researches


Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731-1743. doi:10.1056/NEJMra071600.

Fasano A, Catassi C. Clinical practice. Celiac disease. N Engl J Med. 2012;367(25):2419-2426. doi:10.1056/NEJMcp1113994.

Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA; American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108(5):656-677. doi:10.1038/ajg.2013.79.

Gönen C. Celiac Disease Epidemiology. Turkiye Klinikleri J Gastroenterohepatol-Special Topics. 2015;8(3):3-7. (in Turkish).

Catassi C, Fasano A. Celiac disease diagnosis: simple rules are better than complicated algorithms. Am J Med. 2010;123(8):691-693. doi:10.1016/j.amjmed.2010.02.019.

Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo CA Jr. Age-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease. Clin Transl Gastroenterol. 2012;3(2):e9. doi:10.1038/ctg.2012.4.

Jansson-Knodell CL, King KS, Larson JJ, Van Dyke CT, Murray JA, Rubio-Tapia A. Gender-Based Differences in a Population-Based Cohort with Celiac Disease: More Alike than Unalike. Dig Dis Sci. 2018;63(1):184-192. doi:10.1007/s10620-017-4835-0.

Reilly NR, Aguilar K, Hassid BG, et al. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr. 2011;53(5):528-531. doi:10.1097/MPG.0b013e3182276d5e.

Lurz E, Scheidegger U, Spalinger J, Schöni M, Schibli S. Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children. Eur J Pediatr. 2009;168(7):839-845. doi:10.1007/s00431-008-0845-4.

Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013;5(10):3975-3992. doi:10.3390/nu5103975.

Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007;82(11):996-1000. doi:10.1002/ajh.20996.

McKeon A, Lennon VA, Pittock SJ, Kryzer TJ, Murray J. The neurologic significance of celiac disease biomarkers. Neurology. 2014;83(20):1789-1796. doi:10.1212/WNL.0000000000000970.

Kelly CP, Bai JC, Liu E, Leffler DA. Advances in diagnosis and management of celiac disease. Gastroenterology. 2015;148(6):1175-1186. doi:10.1053/j.gastro.2015.01.044.

MacCulloch K, Rashid M. Factors affecting adherence to a gluten-free diet in children with celiac disease. Paediatr Child Health. 2014;19(6):305-309. doi:10.1093/pch/19.6.305.

Thompson T. Contaminated oats and other gluten-free foods in the United States. J Am Diet Assoc. 2005;105(3):348-349. doi:10.1016/j.jada.2005.01.024.

Annibale B, Severi C, Chistolini A, et al. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol. 2001;96(1):132-137. doi:10.1111/j.1572-0241.2001.03463.x.

Terlemez S, Tokgöz Y. Effects Of Gluten-Free Diet On Hematological Parameters In Children With Celiac Disease. Kocatepe Tıp Dergisi. 2018;19(4):126-130. doi:10.18229/kocatepetip.474987. (in Turkish).

Rawal P, Thapa BR, Prasad R, Prasad KK, Nain CK, Singh K. Zinc supplementation to patients with celiac disease--is it required?. J Trop Pediatr. 2010;56(6):391-397. doi:10.1093/tropej/fmq011.

Halfdanarson TR, Kumar N, Hogan WJ, Murray JA. Copper deficiency in celiac disease. J Clin Gastroenterol. 2009;43(2):162-164. doi:10.1097/MCG.0b013e3181354294.

Stazi AV, Trinti B. Selenium deficiency in celiac disease: risk of autoimmune thyroid diseases. Minerva Med. 2008;99(6):643-653. (in Italian).

Erdem T, Ferat Ç, Nurdan YA, et al. Vitamin and mineral deficiency in children newly diagnosed with celiac disease. Turk J Med Sci. 2015;45(4):833-836.

Ohlund K, Olsson C, Hernell O, Ohlund I. Dietary shortcomings in children on a gluten-free diet. J Hum Nutr Diet. 2010;23(3):294-300. doi:10.1111/j.1365-277X.2010.01060.x.

Unubol M, Guney E, Yazak V, Cakiroglu U, Coskun A, Meteoglu I. Celiac Disease Presenting with Vitamin D Deficiency and Low Bone Mineral Density in the Puerperium. Turkish Journal of Rheumatology. 2012;27(2):136-139. doi:10.5606/tjr.2012.021

Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol. 2001;96(3):745-750. doi:10.1111/j.1572-0241.2001.03616.x.