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April Newsletter - Research

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Are people with coeliac disease meeting current healthy eating guidelines?

A study carried out by Kinsey L et al. showed that patients with coeliac disease are at risk of having an inadequate intake of calcium, NSP (non-starch polysaccharide) and vitamin D and also looked at the importance of obtaining gluten-free food on prescription in meeting nutritional requirements. This study was one of the 11 papers that was included in the Nutritional Adequacy systematic review in 2008 (report published on FSA website).

The research carried out by Kinsey looked at the dietary intakes of people with coeliac disease to see if they were meeting the dietary reference values and compared intakes to the general population. It also looked at the nutritional contribution of gluten-free substitute products and the current purchasing trends of these products. One hundred and six people with diagnosed coeliac disease were invited to take part in the study. Participants completed a 3-day food diary and a short questionnaire about dietary habits. The food diary was returned by 49 individuals and 48 people returned the questionnaire. The food diaries were analysed by a computer programme 'CompEat5'

Patients with coeliac disease are at risk of having a low intake of energy, NSP's, vitamin D and calcium. This research showed dietary intake was comparable to the general population for most nutrients, except people with coeliac disease had a significantly greater intake of protein, a lower intake of fat and a significantly lower intake of vitamin D. The authors concluded that gluten-free substitute products are a very important source of NSP, calcium, iron, carbohydrate and energy. Many people get a major percentage of these nutrients from gluten free substitute products.

It was found that 62% of individuals received gluten-free foods on prescription every 3 to 4 weeks and 17% received their prescription every 5 to 6 weeks. There were 87% of people who bought commercial gluten-free products in addition to their prescriptions.

The gluten-free diet requires the exclusion of many staple foods such as bread, flour and pasta, which are important sources of energy, protein, carbohydrate, iron, calcium, niacin and thiamine. This paper highlights the benefit of gluten-free prescribable products in helping people with coeliac disease to follow a balanced diet. Without these products, patients would find meeting their nutritional requirements more difficult and be at an increased risk of many deficiencies.

For further reading; Kinsey L, Burden ST & Bannerman E. A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population European Journal of Clinical Nutrition 2008; 62: 1333-1342

Age affects diagnosis, symptoms and severity of villous atrophy

A study carried out by Santiago Vivas, MD et al. recently showed significant differences in diagnosis times, symptoms blood test results and degree of villous atrophy (from endoscopy with biopsy) between children and adults with coeliac disease. The study examined 66 children and 54 adults who were diagnosed with coeliac disease between 2000 and 2006. The author put individuals into two categories which included those with typical symptoms (malabsorption, chronic diarrhoea or failure to thrive) and those with atypical symptoms (abdominal pain, iron deficiency anaemia, chronic hypertransaminasemia, growth failure or those with first degree relatives with coeliac disease).

The tests used for diagnosis included a blood test which looked at antibody response to gluten in the diet (anti-tissue transglutaminase or antiendomysium antibody blood test) and a small bowel biopsy. The histological results were divided into mild and severe. The results found that the average time for diagnosis was 7.6 months for children and 90 months for adults. Typical symptoms were found in 62.5% of children and 31% of adults. Typical symptoms were found in 82% of children under 2 years in comparison to 33% in children over 2 years. There was no difference in the symptoms in older children and adults. The results also showed that children had higher antibody levels (tTGA) and a greater degree of villous atrophy than adults and that 86% of children had severe atrophy in comparison to 52% of adults. Those with classic symptoms also had more severe villous atrophy.

Santiago Vivas, M.D et al. Age Related Clinical, Serological and Histopathological Features of Celiac Disease. American Journal of Gastroenterology, 2008; 103: 2360-2365

Screening for coeliac disease in overweight children and adolescents

Weight loss and malnutrition are well known symptoms of coeliac disease. More evidence is becoming available to show coeliac disease can occur in overweight children.

This research project looked at 2,140 overweight patients attending a paediatric nutrition and diet centre in Rome, Italy between 2000- 2008. These individuals were screened for coeliac disease with an antibody blood test. If the test result was positive, endoscopy with a small gut biopsy was carried out.

The results found that of the 2,050 people who completed the study, 25 had a positive antibody blood result. From those 25 people, 12 were diagnosed with coeliac disease via biopsy. The remaining 13 are still undergoing diagnostic procedures. All of the individuals confirmed to have coeliac disease established themselves on a well-balanced gluten-free diet and subsequently experienced weight loss.

The results from this study support the need to recognise that coeliac disease should not be discounted in those who are overweight.

Nenna R, et al. Coeliac Disease Screening in Overweight/Obese Children and Adolescents. Digestive and Liver Disease 2008; 40: A41-A118

Is there a benefit of live probiotic bacteria in coeliac disease?

Researchers in Finland recently investigated whether the probiotics Lactobacillus fermentum or Bifidobacterium lactis (B lactis) could inhibit the toxic effects of gliadin (a part of wheat gluten) in intestinal cell culture conditions.

Intestinal cells respond to gluten in a specific way. When the cells are exposed to gluten there is an increase in the permeability of the epithelial layer which is measured as increased transepithelial resistance. The cells also react to gliadin by reorganising their actin cytoskeleton which results in large membrane ruffles at the edges of cell islets when grown in medium containing gliadin.

In this study human epithelial cells were cultured in a medium. The gliadin was extracted from wheat flour and a bovine serum albumin was used as a control. Lactobacillus fermentum and bifidobacterium lactis probiotic bacterial cell lines were cultured and exposed to the epithelial cells. Transepithelial resistance measurements were taken after the addition of the bovine serum albumin, the gliadin, and/or the probiotic bacteria. These measurements were taken after changing the medium as well as 1, 3, 5 and 24 hours thereafter.

Immunofluorescence was carried out on the intestinal cells and the cells were stained to visualise the membrane ruffle formation. The extent of actin cytoskeleton reorganising was measured by measuring the cellular edge covered by membrane ruffles as a percentage of the total length of the cell cluster.

Data suggested that the addition of the Bifidobacterium to the cell culture medium together with the gliadin stopped the cellular damage that was found when gliadin alone was added to the cell medium. The B lactis addition resulted in a reduction to the transepithelial resistance measurements, and stopped the formation of large membrane ruffles.

The researchers concluded that there could be a benefit of live probiotic Bifidobacterium lactis bacteria on counteracting the toxic effect of wheat gliadin. This study shows the potential benefit of live probiotic bacteria. Further studies are required to look at the potential of a dietary supplement for the treatment of coeliac disease.