Skip to main content
SpringerLink
Log in

Paediatric Patients with Coeliac Disease on a Gluten-Free Diet: Nutritional Adequacy and Macro- and Micronutrient Imbalances

  • Pediatric Gastroenterology (S Orenstein, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

A strict, lifelong gluten-free diet is the cornerstone for management of coeliac disease. Elimination of gluten from the diet may be associated with nutritional imbalance; however, the completeness of this diet in energy and macro- and micronutrients in children is not well described. Understanding the nutritional adequacy of the gluten-free diet in children during this critical period of growth and development when dietary intake is strongly influential is important.

Recent Findings

Children, regardless of whether they have eliminated gluten from their diet, have a tendency to consume excess fat and insufficient fibre, iron, vitamin D and calcium, compared to recommendations. In the context of a gluten-free diet, these imbalances may be worsened or have more significant consequences. Paediatric studies have demonstrated that intakes of folate, magnesium, zinc and selenium may decrease on a gluten-free diet.

Summary

Nutritional inadequacies may be risks of a gluten-free diet in a paediatric population. The potential implications of these inadequacies, both short and long term, remain unclear and warrant further investigation and clarification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Quero JS, Jaime BE, Martínez AR, Martín FA, Jiménez RG, Murillo MR, et al. Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient? Anales de Pediatría (English Edition). 2015;83(1):33–9. https://doi.org/10.1016/j.anpede.2015.06.003.

    Article  Google Scholar 

  2. Niewinski MM. Advances in celiac disease and gluten-free diet. J Am Diet Assoc. 2008;108(4):661–72. https://doi.org/10.1016/j.jada.2008.01.011.

    Article  PubMed  Google Scholar 

  3. Dubé C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005;128(4):S57–67. https://doi.org/10.1053/j.gastro.2005.02.014.

    Article  PubMed  Google Scholar 

  4. Gelfond D, Fasano A. Celiac disease in the pediatric population. Pediatr Ann. 2006;35(4):275–9. https://doi.org/10.3928/0090-4481-20060401-12.

    Article  PubMed  Google Scholar 

  5. Hill ID, Bhatnagar S, Cameron DJ, De Rosa S, Maki M, Russell GJ, et al. Celiac disease: working group report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2002;35:S78–88. https://doi.org/10.1097/00005176-200208002-00004.

    Article  PubMed  Google Scholar 

  6. Shepherd S, Gibson P. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013;26(4):349–58. https://doi.org/10.1111/jhn.12018.

    Article  CAS  PubMed  Google Scholar 

  7. DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scand J Gastroenterol. 2013;48(8):921–5. https://doi.org/10.3109/00365521.2013.809598.

    Article  PubMed  Google Scholar 

  8. Bardella MT, Fredella C, Prampolini L, Molteni N, Giunta AM, Bianchi PA. Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. Am J Clin Nutr. 2000;72(4):937–9.

    Article  CAS  PubMed  Google Scholar 

  9. Hallert C, Grant C, Grehn S, Granno C, Hulten S, Midhagen G, et al. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther. 2002;16(7):1333–9. https://doi.org/10.1046/j.1365-2036.2002.01283.x.

    Article  CAS  PubMed  Google Scholar 

  10. Caponio F, Summo C, Clodoveo ML, Pasqualone A. Evaluation of the nutritional quality of the lipid fraction of gluten-free biscuits. Eur Food Res Technol. 2008;227(1):135–9. https://doi.org/10.1007/s00217-007-0702-0.

    Article  CAS  Google Scholar 

  11. Kulai T, Rashid M. Assessment of nutritional adequacy of packaged gluten-free food products. Can J Diet Pract Res. 2014;75(4):186–90. https://doi.org/10.3148/cjdpr-2014-022.

    Article  PubMed  Google Scholar 

  12. Miranda J, Lasa A, Bustamante M, Churruca I, Simon E. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum Nutr. 2014;69(2):182–7. https://doi.org/10.1007/s11130-014-0410-4.

    Article  CAS  PubMed  Google Scholar 

  13. Segura ME, Rosell CM. Chemical composition and starch digestibility of different gluten-free breads. Plant Foods Hum Nutr. 2011;66(3):224–30. https://doi.org/10.1007/s11130-011-0244-2.

    Article  PubMed  Google Scholar 

  14. Thompson T. Thiamin, riboflavin, and niacin contents of the gluten-free diet: is there cause for concern? J Am Diet Assoc. 1999;99(7):858–62. https://doi.org/10.1016/S0002-8223(99)00205-9.

    Article  CAS  PubMed  Google Scholar 

  15. Thompson T. Folate, iron, and dietary fiber contents of the gluten-free diet. J Am Diet Assoc. 2000;100(11):1389–96. https://doi.org/10.1016/S0002-8223(00)00386-2.

    Article  CAS  PubMed  Google Scholar 

  16. Wu JH, Neal B, Trevena H, Crino M, Stuart-Smith W, Faulkner-Hogg K, et al. Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia. Br J Nutr. 2015;114(03):448–54.

    Article  CAS  PubMed  Google Scholar 

  17. Kautto E, Rydén P, Ivarsson A, Olsson C, Norström F, Högberg L, et al. What happens to food choices when a gluten-free diet is required? A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers. J Nutr Sci. 2014;3 https://doi.org/10.1017/jns.2013.24.

  18. Houben A, Höchstötter A, Becker T. Possibilities to increase the quality in gluten-free bread production: an overview. Eur Food Res Technol. 2012;235(2):195–208. https://doi.org/10.1007/s00217-012-1720-0.

    Article  CAS  Google Scholar 

  19. Ferrara P, Cicala M, Tiberi E, Spadaccio C, Marcella L, Gatto A, et al. High fat consumption in children with celiac disease. Acta Gastro-Enterol Belg. 2009;72(3):296–300.

    CAS  Google Scholar 

  20. •• Kautto E, Ivarsson A, Norstrom F, Hogberg L, Carlsson A, Hornell A. Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries. J Hum Nutr Diet. 2014;27(1):41–53. Relatively recently published case-control study on children with coeliac disease with well-documented methodology and has conducted subanalysis by gender.

    Article  CAS  PubMed  Google Scholar 

  21. • Balamtekin N, Aksoy C, Baysoy G, Uslu N, Demir H, Koksal G, et al. Is compliance with gluten-free diet sufficient? Diet composition of celiac patients. Turkish J Pediatr. 2015;57(4):374–9. Recently published case-control study that has compared children with coeliac disease on long-term gluten-free diets (at least 1 year) to controls.

    Google Scholar 

  22. •• Babio N, Alcázar M, Castillejo G, Recasens M, Martínez-Cerezo F, Gutiérrez-Pensado V, et al. Patients with celiac disease reported higher consumption of added sugar and total fat than healthy individuals. J Pediatr Gastroenterol Nutr. 2017, 64;(1):63–9. Largest and most recently published case-control study conducted in children with coeliac disease and the only study to match cases and controls by age, gender and BMI.

  23. Mariani P, Viti MG, Montuori M, La Vecchia A, Cipolletta E, Calvani L, et al. The gluten-free diet: a nutritional risk factor for adolescents with celiac disease? J Pediatr Gastroenterol Nutr. 1998;27(5):519–23. https://doi.org/10.1097/00005176-199811000-00004.

    Article  CAS  PubMed  Google Scholar 

  24. Rujner J, Socha J, Syczewska M, Wojtasik A, Kunachowicz H, Stolarczyk A. Magnesium status in children and adolescents with coeliac disease without malabsorption symptoms. Clin Nutr. 2004;23(5):1074–9. https://doi.org/10.1016/j.clnu.2003.10.018.

    Article  CAS  PubMed  Google Scholar 

  25. Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, et al. Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr. 2014;68(6):700–6. https://doi.org/10.1038/ejcn.2013.286.

    Article  CAS  PubMed  Google Scholar 

  26. Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, Mager D. Assessing nutritional quality and adherence to the gluten-free diet in children and adolescents with celiac disease. Can J Dietetic Prac Res. 2015;76(2):56–63. https://doi.org/10.3148/cjdpr-2014-040.

    Article  Google Scholar 

  27. Zuccotti G, Fabiano V, Dilillo D, Picca M, Cravidi C, Brambilla P. Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products. J Hum Nutr Diet. 2013;26(5):436–44. https://doi.org/10.1111/jhn.12026.

    Article  CAS  PubMed  Google Scholar 

  28. Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F, Danchielli C. Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr. 2010;64(11):1371–2. https://doi.org/10.1038/ejcn.2010.161.

    Article  CAS  PubMed  Google Scholar 

  29. Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9. https://doi.org/10.1056/NEJMoa1000367.

    Article  CAS  PubMed  Google Scholar 

  30. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9(1):88. https://doi.org/10.1186/1471-2458-9-88.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hopman EG, le Cessie S, von Blomberg BM, Mearin ML. Nutritional management of the gluten-free diet in young people with celiac disease in The Netherlands. J Pediatr Gastroenterol Nutr. 2006;43(1):102–8. https://doi.org/10.1097/01.mpg.0000228102.89454.eb.

    Article  CAS  PubMed  Google Scholar 

  32. 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. https://doi.org/10.1111/j.1365-277X.2010.01060.x.

    Article  CAS  PubMed  Google Scholar 

  33. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341–54.

    Article  CAS  PubMed  Google Scholar 

  34. Tokudome Y, Imaeda N, Nagaya T, Ikeda M, Fujiwara N, Sato J, et al. Daily, weekly, seasonal, within-and between-individual variation in nutrient intake according to four season consecutive 7 day weighed diet records in Japanese female dietitians. J Epidemiol. 2002;12(2):85–92. https://doi.org/10.2188/jea.12.85.

    Article  PubMed  Google Scholar 

  35. Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet. 2005;18(3):163–9. https://doi.org/10.1111/j.1365-277X.2005.00607.x.

    Article  CAS  PubMed  Google Scholar 

  36. Martin J, Geisel T, Maresch C, Krieger K, Stein J. Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion. 2013;87(4):240–6. https://doi.org/10.1159/000348850.

    Article  CAS  PubMed  Google Scholar 

  37. Kylökäs A, Kaukinen K, Huhtala H, Collin P, Mäki M, Kurppa K. Type 1 and type 2 diabetes in celiac disease: prevalence and effect on clinical and histological presentation. BMC Gastroenterol. 2016;16(1):76. https://doi.org/10.1186/s12876-016-0488-2.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Shergill-Bonner R. Micronutrients. Paediatr Child Health. 2013;23(8):331–6. https://doi.org/10.1016/j.paed.2013.05.005.

    Article  Google Scholar 

  39. Annibale B, Severi C, Chistolini A, Antonelli G, Lahner E, Marcheggiano 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):132–7. https://doi.org/10.1111/j.1572-0241.2001.03463.x.

    Article  CAS  PubMed  Google Scholar 

  40. Mager D, Qiao J, Turner J. Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease. Eur J Clin Nutr. 2012;66(4):488–95. https://doi.org/10.1038/ejcn.2011.176.

    Article  CAS  PubMed  Google Scholar 

  41. Forchielli ML, Fernicola P, Diani L, Scrivo B, Salfi NC, Pessina AC, et al. Gluten-free diet and lipid profile in children with celiac disease: comparison with general population standards. J Pediatr Gastroenterol Nutr. 2015;61(2):224–9. https://doi.org/10.1097/MPG.0000000000000785.

    Article  CAS  PubMed  Google Scholar 

  42. Jastrebova J, Jägerstad M. Novel fortification strategies for staple gluten-free products. In: Preedy VR, Srirajaskanthan R, Patel VB, editors. Handbook of food fortification and health: from concepts to public health applications volume 1. New York: Springer New York; 2013. p. 307–20. https://doi.org/10.1007/978-1-4614-7076-2_24.

    Chapter  Google Scholar 

  43. Ma Y, Peng D, Liu C, Huang C, Luo J. Serum high concentrations of homocysteine and low levels of folic acid and vitamin B 12 are significantly correlated with the categories of coronary artery diseases. BMC Cardiovasc Disord. 2017;17(1):37. https://doi.org/10.1186/s12872-017-0475-8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Barera G, Beccio S, Proverbio MC, Mora S. Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a gluten-free diet. Am J Clin Nutr. 2004;79(1):148–54.

    Article  CAS  PubMed  Google Scholar 

  45. Barera G, Mora S, Brambilla P, Ricotti A, Menni L, Beccio S, et al. Body composition in children with celiac disease and the effects of a gluten-free diet: a prospective case-control study. Am J Clin Nutr. 2000;72(1):71–5.

    Article  CAS  PubMed  Google Scholar 

  46. Blazina Š, Bratanič N, Čampa AŠ, Blagus R, Orel, R. Bone mineral density and importance of strict gluten-free diet in children and adolescents with celiac disease. Bone. 2010;47(3):598–603. https://doi.org/10.1016/j.bone.2010.06.008.

  47. Holick MF. Sunlight “D” ilemma: risk of skin cancer or bone disease and muscle weakness. Lancet. 2001;357(9249):4–6. https://doi.org/10.1016/S0140-6736(00)03560-1.

    Article  CAS  PubMed  Google Scholar 

  48. Scott EM, Gaywood I, Scott BB. Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut. 2000;46(suppl 1):I1–8. https://doi.org/10.1136/gut.46.suppl_1.I1.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Discipline of Paediatrics, School of Women’s and Children’s Health, Medicine, University of New South Wales, Sydney, New South Wales, 2031, Australia

    Alison Sue & Chee Y. Ooi

  2. Department of Nutrition and Dietetics, Sydney Children’s Hospital, Randwick, New South Wales, 2031, Australia

    Kate Dehlsen

  3. Department of Paediatric Gastroenterology, Sydney Children’s Hospital, Randwick, New South Wales, 2031, Australia

    Chee Y. Ooi

Authors
  1. Alison Sue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate Dehlsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chee Y. Ooi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chee Y. Ooi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Gastroenterology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sue, A., Dehlsen, K. & Ooi, C.Y. Paediatric Patients with Coeliac Disease on a Gluten-Free Diet: Nutritional Adequacy and Macro- and Micronutrient Imbalances. Curr Gastroenterol Rep 20, 2 (2018). https://doi.org/10.1007/s11894-018-0606-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-018-0606-0

Keywords

Search

Navigation