Patients with coeliac disease reported higher consumption of added sugar and total fat than healthy individuals
Babio N, Alcazar M, Castillejo G
Journal of Paed Gastro & Nutr. E-pub ahead of print DOI: 10.1097/MPG.0000000000001251
The gluten free diet (GFD) is understood to be restrictive and may compromise the macro- and micronutrient content of the diet if healthy eating advice and support if not adequately provided and adhered to. This is of particular importance to children and adolescents who may have additional nutritional requirements to fuel growth and development. In the UK, staple gluten free products are available on prescription to most coeliac patients.
Journal of Paed Gastro & Nutr. E-pub ahead of print DOI: 10.1097/MPG.0000000000001251
The gluten free diet (GFD) is understood to be restrictive and may compromise the macro- and micronutrient content of the diet if healthy eating advice and support if not adequately provided and adhered to. This is of particular importance to children and adolescents who may have additional nutritional requirements to fuel growth and development. In the UK, staple gluten free products are available on prescription to most coeliac patients.
This provision helps to support compliance with a gluten free diet and bolster nutritional intake, since the majority of main-brand prescription products are fortified with additional vitamins, minerals and fibre. However, in Spain (the country of origin for the present study), gluten-free foods are only available to purchase in retail outlets, and those that are available are not routinely fortified with additional nutrients.
The aim of this study was to compare the food and nutrient intake of patients with CD aged between 10-23 years old with non-coeliac controls matched by age, gender and BMI. Subjects were recruited between October 2012 and June 2014. Cases all had CD confirmed by positive serology and biopsy at the Gatroenterology Unit of Sant Joan University Hospital in Reus, Spain. Healthy participants were volunteers recruited from surrounding schools. All participants were interviewed on 2 occasions in order to extract study data. In the first interview, a trained dietitian collected sociodemographic and personal data, alongside information relating to family history, medication use and physical activity levels. Subjects were also educated on how to complete a 3-day non-consecutive food record using household measures to estimate intake (data collected for 2 weekdays and 1 weekend day). During the 2nd interview, the food record was collected and checked by the same dietitian in the presence of the subject and their parents. Subjects were also weighed, measured and BMI calculated. Nutritional intake from food records was analysed using Spanish food composition data. The nutritional composition of any specialist gluten free foods consumed was collected in a database specifically developed for this study.
Ninety eight cases were matched with 98 controls by age, gender and BMI. Mean age was 15.3 ± 3.7 years, and mean BMI was 19.4 ± 2.7 kg/m2. CD cases reported significantly lower intakes of starch and higher consumption of added sugar (P<0.001) and total fat (0.017). The higher intake of sugar-sweetened beverages and processed meats amongst CD cases is likely to have contributed to these findings. Micronutrient intake was below national nutritional recommendations for folic acid calcium, iron and magnesium across both case and control groups. However, CD patients showed a significantly lower percentage of adherence to recommendations for each of these nutrients, furthermore, subjects with CD generally had a worse nutrient density (nutrients for kcal) than controls. Perhaps this may in part be explained by the fact that foods rich in starch (as were found to be consumed in smaller amounts by CD children in this study) are often fortified with micronutrients, whereas gluten-free products sold in Spain are not. Interestingly, results were similar even after the data was adjusted for parental education.
The results of this study suggest that children with CD living in Spain have a more unbalanced diet. Better education and economic support for families living with CD may help to relieve a situation where, consciously or unconsciously, intakes of starchy foods are reduced and intakes of foods richer in fats and/ or protein, alongside sugar sweetened beverages are consumed more frequently in order to maintain energy intakes
Link to original paper
The aim of this study was to compare the food and nutrient intake of patients with CD aged between 10-23 years old with non-coeliac controls matched by age, gender and BMI. Subjects were recruited between October 2012 and June 2014. Cases all had CD confirmed by positive serology and biopsy at the Gatroenterology Unit of Sant Joan University Hospital in Reus, Spain. Healthy participants were volunteers recruited from surrounding schools. All participants were interviewed on 2 occasions in order to extract study data. In the first interview, a trained dietitian collected sociodemographic and personal data, alongside information relating to family history, medication use and physical activity levels. Subjects were also educated on how to complete a 3-day non-consecutive food record using household measures to estimate intake (data collected for 2 weekdays and 1 weekend day). During the 2nd interview, the food record was collected and checked by the same dietitian in the presence of the subject and their parents. Subjects were also weighed, measured and BMI calculated. Nutritional intake from food records was analysed using Spanish food composition data. The nutritional composition of any specialist gluten free foods consumed was collected in a database specifically developed for this study.
Ninety eight cases were matched with 98 controls by age, gender and BMI. Mean age was 15.3 ± 3.7 years, and mean BMI was 19.4 ± 2.7 kg/m2. CD cases reported significantly lower intakes of starch and higher consumption of added sugar (P<0.001) and total fat (0.017). The higher intake of sugar-sweetened beverages and processed meats amongst CD cases is likely to have contributed to these findings. Micronutrient intake was below national nutritional recommendations for folic acid calcium, iron and magnesium across both case and control groups. However, CD patients showed a significantly lower percentage of adherence to recommendations for each of these nutrients, furthermore, subjects with CD generally had a worse nutrient density (nutrients for kcal) than controls. Perhaps this may in part be explained by the fact that foods rich in starch (as were found to be consumed in smaller amounts by CD children in this study) are often fortified with micronutrients, whereas gluten-free products sold in Spain are not. Interestingly, results were similar even after the data was adjusted for parental education.
The results of this study suggest that children with CD living in Spain have a more unbalanced diet. Better education and economic support for families living with CD may help to relieve a situation where, consciously or unconsciously, intakes of starchy foods are reduced and intakes of foods richer in fats and/ or protein, alongside sugar sweetened beverages are consumed more frequently in order to maintain energy intakes
Link to original paper
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