Eureka! Institutional Repository

Introduction: Coeliac disease (CD) is a chronic, immune-mediated enteropathy of the small intestine in genetically predisposed individuals, triggered by the consumption of gluten. Clinical manifestations of the disease can be classified to gastrointestinal and extra-intestinal, or both. They remain if villous atrophy is no treated, leading to potential micronutrient deficiencies. The only available treatment is a life-long gluten free diet to achieve villi recovery and improve the micronutrient status. However, the gluten free diet is a restricted diet and may result in ongoing micronutrient deficiencies, thus micronutrient status was assessed in children with celiac disease and compared after they adhered to the appropriate diet. Methods: The two cohort groups included paediatric patients (<16 years) from the Royal Hospital for Sick Children, Glasgow, UK. The first included a single sample from 55 long-standing patients with previous diagnosis of CD. Out of those 55, 10 patients were regrouped to different groups; six children on 6th month and four children on 12th month after diagnosis. The second included 27 newly diagnosed patients with follow-ups at 6 and 12 months. After blood samples were collected, analysis of vitamins and trace elements was performed. Micronutrient status was compared between the two cohort groups. Also, comparisons occurred between newly diagnosed children and their follow-up visit to determine any differences at different stages of CD. Results: Significant differences of vitamin A, E, K, B1, B2 and B6, plasma magnesium and ferritin occurred in the two cohort groups. Specifically, long-standing patients had significantly higher levels of vitamin E compared to patient at diagnosis (P<0.001), at 6 months (P<0.001) and 12 months (P<0.001) after diagnosis. Similar results were achieved for vitamin K, vitamin B complex and plasma magnesium. Moreover, long-standing patients showed an improved ferritin status compared to children at diagnosis (P<0.001). Vitamin A levels seem to decline in long-standing patients compared to children at their 12th month since diagnosis (P=0.038). Additional significant differences were present in the second group. Newly diagnosed children seem to have higher levels of vitamin E (P=0.049), B1 (P=0.033), and B12 (P=0.021) and ferritin (P<0.001) at their follow-up visits. Contrary, vitamin B1 present a decline in its levels after diagnosis of CD (P=0.005). Present study did not show any significant differences among CD children in concern of other micronutrients. All children had inadequate levels of every micronutrient except for vitamin B2, B12 and folate. Conclusion: Micronutrient deficiencies are present in celiac paediatric patients and their levels seem to differ at different time points of the disease. Gluten free diet seems to have a good impact on improved micronutrient status as the time passes, even though some micronutrients remain at inadequate levels. Clinical evaluation of micronutrient status is advised to be practiced for at least a year after diagnosis. Future studies should examine the micronutrient status in larger population, prior- and post- adherence to GFD and address the lack of micronutrient assessment in long-term CD patients.