Abstract
Introduction: Celiac Disease (CD) is a chronic immune-mediated enteropathy precipitated by dietary exposure to gluten in genetically predisposed individuals. The CD has been reported as a rare disease, with an estimated prevalence of 0.3 to 2% worldwide. Objective: This study aimed to review the literature on the role of a gluten-free diet in cardiovascular risk factors in patients with celiac disease, specifically related to lipid profile, body mass index, and diabetes mellitus. Methods: This is a non-systematic literature review study, carried out from July to October 2017. Relevant publications available in the PubMed and BIREME databases were identified. The literature review included randomized controlled trials, cohort studies, casecontrol studies, and cross-sectional analyses. Results and Conclusion: CD it is a disease of special interest due to its association with other autoimmune disorders, intestinal malabsorption, with specific comorbidities, and because its main control mechanism is dietary therapy: the Gluten-Free Diet. Bearing in mind the increase in the worldwide prevalence of celiac disease and its relationship with cardiovascular risk, which may be attributable both to the pathophysiological role of the disease and to the therapeutic plan (dietary), scientific investment in this sphere of public health becomes more than necessary. The influence of gluten-free diet on the cardiovascular risk parameters studied in this review is still not entirely clear. Some studies have suggested that gluten-free diet may have a beneficial effect on the lipid profile of celiac patients, while others have shown that the diet probably does not change or induce atherosclerosis by raising the lipid profile of these patients. In addition, by altering caloric and glycemic intake, the reviewed studies demonstrated a greater tendency towards hyperglycemia and the development of insulin resistance in celiac patients on gluten-free diet. As well as there was a trend towards an increase in body mass index after the introduction of gluten-free diet. However, some authors report that based on these available data, it is not possible to state whether there is a better or worse cardiovascular risk profile after the introduction of gluten-free diet, and therefore, continuity with clinical studies is necessary.
Metrics
References
- Ludvigsson JF, Biagi F, Kelly C, Murray JA. The Oslo definitions for coeliac disease and related terms. 2014;62(1):43–52.
- Theethira TG, Dennis M. Celiac disease and the gluten-free diet: consequences and recommendations for improvement. Dig Dis. 2015;33(2):175–82.
- Lohi S, Mustalahti K, Kaukinen K, Laurila K, Collin P, Rissanen H, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217–25.
- Chawla A. Diagnosis and management of celiac disease. Clin Nutr Insight [Internet]. 2010;36(1):1–4. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=2010507714&authtype=athens&site=ehost-live.
- Schuppan D, Zimmer K. The Diagnosis and Treatment of Celiac Disease. 2013;110(49).
- Cochain C, Koch M, Chaudhari SM, Busch M, Pelisek J, Boon L, et al. CD8+ T Cells Regulate Monopoiesis and Circulating Ly6Chigh Monocyte Levels in Atherosclerosis in Mice. Circ Res [Internet]. 2015;117(April 2015):244–53. Available from: http://circres.ahajournals.org/content/circresaha/117/3/244.full.pdf
- Kotfis K, Biernawska J, Zegan-Barańska M, Żukowski M. Peripheral Blood Lymphocyte Subsets (CD4 + , CD8 + T Cells, NK Cells) in Patients with Cardiovascular and Neurological Complications after Carotid Endarterectomy. Int J Mol Sci [Internet]. 2015;16:10077–94. Available from: www.mdpi.com/journal/ijms
- Mazzarella G, Stefanile R, Camarca A, Giliberti P, Cosentini E, Marano C, et al. Gliadin Activates HLA Class I-Restricted CD8+ T Cells in Celiac Disease Intestinal Mucosa and Induces the Enterocyte Apoptosis. Gastroenterology. 2008;134(4):1017–27.
- Askling J. Causes of Death in Patients With Celiac Disease in a Population-Based Swedish Cohort. Arch Intern Med. 2003;163:1566–72.
- Viljamaa M, Kaukinen K, Pukkala E, Hervonen K, Reunala T, Collin P. Malignancies and mortality in patients with coeliac disease and dermatitis herpetiformis: 30-year population-based study. Dig Liver Dis. 2006;38(6):374– 80.
- Curione M, Barbato M, Viola F, Francia P, De Biase L, Cucchiara S. Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance. Dig Liver Dis. 2002;34(12):866–9.
- De Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther. 2013;38(2):162–9.
- Rybak A, Cukrowska B, Socha J, Socha P. Long Term Follow Up of Celiac Disease—Is Atherosclerosis a Problem? Nutrients. 2014;6(7):2718–29.
- Wang I, Hopper I. Celiac disease and drug absorption: Implications for cardiovascular therapeutics. Cardiovasc Ther. 2014;32(6):253–6.
- Bayar N, Çağırcı G, Üreyen ÇM, Kuş G, Küçükseymen S, Arslan Ş. The Relationship between Spontaneous Multi-Vessel Coronary Artery Dissection and Celiac Disease. Korean Circ J [Internet]. 2015;45(3):242–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26023313
- Forchielli ML, Fernicola P, Diani L, Scrivo B, Salfi NC, Pessina AC, et al. GlutenFree Diet and Lipid Profile in Children With Celiac Disease: Comparison With General Population Standards. J Pediatr Gastroenterol Nutr. 2015 Aug;61(2):224–
- Kabbani TA, Goldberg A, Kelly CP, Pallav K, Tariq S, Peer A, et al. Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment Pharmacol Ther. 2012;35(6):723–9.
- Ukkola A, Mäki M, Kurppa K, Collin P, Huhtala H, Kekkonen L, et al. Changes in body mass index on a gluten-free diet in coeliac disease: A nationwide study. Eur J Intern Med [Internet]. 2012;23(4):384–8. Available from: http://dx.doi.org/10.1016/j.ejim.2011.12.012
- Shepherd SJ, Gibson PR. 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.
- Norsa L, Shamir R, Zevit N, Verduci E, Hartman C, Ghisleni D, et al. Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets. World J Gastroenterol. 2013;19(34):5658–64.
- Lewis NR, Sanders DS, Logan RFA, Fleming KM, Hubbard RB, West J. Cholesterol profile in people with newly diagnosed coeliac disease: a comparison with the general population and changes following treatment. Br J Nutr. 2009 Aug;102(4):509–13.
- Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation [Internet]. 1979;59(1):8–13. Available from: http://circ.ahajournals.org/cgi/doi/10.1161/01.CIR.59.1.8
- Mahmooda SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular diseases: A historical perspective. Lancet [Internet]. 2014;383(9921):1933–45. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159698/pdf/nihms588573.pdf
- Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26- year follow-up of participants in the Framingham Heart Study. Circulation [Internet]. 1983;67(5):968–77. Available from: http://circ.ahajournals.org/cgi/doi/10.1161/01.CIR.67.5.968
- Brar P, Kwon GY, Holleran S, Bai D, Tall AR, Ramakrishnan R, et al. Change in Lipid Profile in Celiac Disease: Beneficial Effect of Gluten-Free Diet. Am J Med. 2006;119(9):786–90.
- Editor TOTHE, States U, Diseases M. Low-Serum High-Density LipoproteinCholesterol Concentration as a Sign of Celiac Disease Inflammatory Bowel Diseases Are Diseases of Higher Socioeconomic Status : Dogma or Reality ? 2000;3331–2.
- Zanini B, Caselani F, Magni A, Turini D, Ferraresi A, Lanzarotto F, Villanacci V, Carabellese N, Ricci C, Lanzini A. Celiac disease with mild enteropathy is not mild disease. Clin Gastroenterol Hepatol. 2013 Mar;11(3):253-8. doi: 10.1016/j.cgh.2012.09.027.
- Tortora R, Capone P, De Stefano G, Imperatore N, Gerbino N, Donetto S, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther. 2015 Feb;41(4):352–9.
- Lee SK, Lo W, Memeo L, Rotterdam H, Green PHR. Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc. 2003;57(2):187–91.
- Wahab PJ, Meijer JWR, Mulder CJJ. Histologic follow-up of people with celiac disease on a gluten-free diet: Slow and incomplete recovery. Am J Clin Pathol. 2002;118(3):459–63.
- Dickey W, Kearney N. Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet. Am J Gastroenterol [Internet]. 2006;101(10):2356–9. Available from: http://www.nature.com/doifinder/10.1111/j.1572-0241.2006.00750.x
- Polsky S, Ellis SL. Obesity, insulin resistance, and type 1 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes [Internet]. 2015;22(4):277–82. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=0 1266029-201508000-00005
- Koro CE, Bowlin SJ, Bourgeois N, Fedder DO. Glycemic Control From 1988 to 2000 Among U.S. Adults Diagnosed With Type 2 Diabetes. Diabetes Care. 2004;27(1):17–20.
- Kizilgul M, Ozcelik O, Beysel S, Akinci H, Kan S, Ucan B, et al. Screening for celiac disease in poorly controlled type 2 diabetes mellitus: worth it or not? BMC Endocr Disord [Internet]. 2017;17(1):62. Available from: http://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-017-0212-4
- Elfström P, Sundström J, Ludvigsson JF. Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes. Aliment Pharmacol Ther [Internet]. 2014;40(10):1123–32. Available from: http://doi.wiley.com/10.1111/apt.12973
- Velloso LA, Eizirik DL, Cnop M. Type 2 diabetes mellitus—an autoimmune disease? Nat Rev Endocrinol [Internet]. 2013;9(12):750–5. Available from: http://www.nature.com/doifinder/10.1038/nrendo.2013.131
- 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 [Internet]. 2016;16(1):76. Available from: http://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0488-2
- Parker SC, Dornhost A, Frost GS. The glycaemic index of a range of gluten free foods. Diabetics Med [Internet]. 2000;17:657–60. Available from: http://dx.doi.org/10.1046/j.1464-5491.2000.00356.x
- Luciani A, Villella VR, Vasaturo A, Giardino I, Pettoello-Mantovani M, Guido S, et al. Lysosomal accumulation of gliadin p31-43 peptide induces oxidative stress and tissue transglutaminase-mediated PPAR downregulation in intestinal epithelial cells and coeliac mucosa. Gut [Internet]. 2010;59(3):311–9. Available from: http://gut.bmj.com/cgi/doi/10.1136/gut.2009.183608
- Wheeler E, Barroso I. Genome-wide association studies and type 2 diabetes. Brief Funct Genomics. 2011;10(2):52–60.
- De Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther. 2013 Jul;38(2):162–9.