Life and food habits in celiac obese/ overweight children and adolescents at diagnosis compared to the non celiac ones.

 

Raffaella Nenna, Laura Petrarca, Margherita Bonamico, Maurizio Mennini, Antonella Mosca, Roberta Mercurio, Alessandra Piedimonte, and Andrea Vania

Department of Paediatrics and Paediatric Neuropsychiatry, “Sapienza” University of Rome, Rome Italy.

 

Address correspondence and reprint requests to:

Dr. Raffaella Nenna,

Department of Paediatrics “Sapienza” University of Rome.

Viale Regina Elena 324, 00161 Rome – Italy

Tel. 39 06 49979375

E-mail: raffaella.nenna@uniroma1.it

 

ABSTRACT

Celiac disease (CD) is a complex autoimmune disorder, whose prevalence is about 1% in general population. Traditionally considered only as a malabsorption disorder, CD can manifest itself in many ways, so that a CD diagnosis may be performed also in overweight/ obese patient. Our study demonstrate that there are no differences in qualitative and quantitative mistakes in food frequency and in life habits in celiac obese/ overweight children and adolescents at diagnosis compared to the non celiac ones.

 

INTRODUCTION

Celiac disease (CD) is a complex autoimmune disorder that occurs in genetically predisposed individuals exposed to gluten. The prevalence of CD is estimated to be 0.5% to 1% in the general population (1,2).

CD has been traditionally regarded as a malabsorption disorder, with a clinical presentation characterized by weight loss, diarrhea, abdominal distension and abdominal pain. However the widespread use of serological tests has changed the clinical spectrum of CD, so that non gastrointestinal symptoms, such as short stature, anemia and osteopenia are now considered atypical presentation of the disease.

The possibility that an overweight / obese patient could be affected by CD has been considered for a long time a taboo.

However recently we demonstrated that CD prevalence in overweight/obese is similar to the general paediatric population in Italy (3).

Obesity is widespread among children and adolescents in the United States and in Europe with a quite doubled prevalence in a single generation (4). In Italy the prevalence of overweight and obesity is 31.1% and 14.3% respectively (5). In paediatric celiac patients the prevalence of obesity resulted below that in general population, with range from 5 to 9% (6-8).

The aim of our study was to evaluate the qualitative and quantitative mistakes in food frequency and the life habits in celiac obese/ overweight children and adolescents at diagnosis compared to the non celiac ones.

 

METHODS

We retrospectively reviewed the data of 1527 children (727 males, median age 10.82 years, age range from 2.05 to 24.17 years) who attended the Paediatric Nutrition and Dietetics Centre of “Sapienza” University of Rome over the period January 1998 – June 2013. Seventeen out of 1527 were celiac patients at diagnosis.

Anamnestic data was recorded with a structured non-validated questionnaire. In particular: personal attitude to nutrition; food frequency (dietary habits and meals’ rhythms and frequency); physical activity; sedentariness’ factors; smoking, alcohol and other substances’ consumption, in adolescents. Qualitative and quantitative mistakes in food frequency were recorded. It has been rated the quality of the nutrient that is the correct fractionation of 50% carbohydrate, 30% lipids, 20% protein, vitamins and minerals. Moreover we calculated the amount taken of different nutrients, according to the food frequency, and then compared with the values reported in the LARN (http://www.sinu.it/html/pag/nuovi_larn.asp) to each Feeding history was reported on the presence of errors qualitative, quantitative or qualitative-quantitative.

Patients were divided into two groups according to CD diagnosis.

 

Statistical analysis

Statistical analysis was performed with SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). Unless otherwise indicated, all values were reported as mean±standard deviation (SD). A chi-squared test, or the Fisher’s exact test if required, was applied for the qualitative analyses. A p value <0.05 was considered significant.

 

tab1

Table 1 Qualitative and quantitative mistakes in food frequency in our obese/overweight celiac and non celiac patients. (*Mann-Whitney U-Test)

 

RESULTS

The retrospective analysis of data shows that celiac patients spend 3.39 ± 1.83 hours/day in sedentary activities, 2.75 ± 2.22 hours/day in sport activities and 8.11 ± 0.92 hours/day sleeping, while non-celiac patients spend 3.94± 1.75 hours/day (p=0.22), 2.87 ± 2.53 hours/day (p=0.74) and 8.94± 0.98 hours/day (p=0.02) in each kind of activity, respectively.

Among the 17 CD patients, 11 (64.7 %) have breakfast, 13 (76.47 %) have morning snack and 11 (64.7%) have afternoon snack, with no significant differences when compared to 1510 non celiac-patients: 988 (65.43%), 1206 (79.88%) and 1067 (70.68%), respectively, with the three reported meals.

Table 1 shows qualitative and quantitative mistakes in food frequency in our obese/overweight celiac and non celiac patients.

Three (17.64%) celiac patients consume soft drinks once/week and 14 (82.35%) twice/week, while among non-celiac patients 312 (20.66%) make use of them once/week and 1324 (87.68%) twice/week, respectively (Table 2). None declare taking alcohol or smoking.

 

tab2

Table 2 Consumption of soft drinks and junk food in obese/overweight celiac and non celiac patients. (*Mann-Whitney U-Test)

 

DISCUSSION

The way of life of obese celiac patients is comparable to that of the non-celiac obese population studied. In the two populations hours of daytime inactivity are comparable, as the weekly hours of sport. A difference emerges between the hours of sleep: celiac children sleep less than other obese patients (8.72 ± 0.91 hours vs. 9.31 ± 0.92 hours, p=0.02).

The distribution of the meals is essential for a healthy diet: the energy distribution of daily calories at breakfast provides 15-25%, 25-35% at lunch, 20 to 30% at dinner and 5-15% in two snacks. Some studies show that breakfast already represents a way of preventing the development of obesity with a significant impact on food intake in subsequent meals (especially lunch).

Unfortunately, among our obese patients, breakfast is one of the most escaped meals. Among celiac patients, the percentage of those who do not have breakfast is even higher (35.3%). This bad habit does not help losing weight, but, on the contrary, alters blood glucose profile and insulin secretion, leading to the establishment of insulin resistance (9).

In our obese population the nutritional errors during the 5 meals happen most frequently during breakfast and snack as for the quantitative aspects; errors for lunch, often eaten at school or at home with their grandparents, are both quantitative and qualitative, while dinner errors are mainly qualitative. Our patients who have breakfast admit to overdoing portions of cookies or cereals, well beyond their needs.

Another bad habit we found among obese children, even in celiac patients, is the consumption of soft drinks at least twice/week, as well as of junk-food: both habits seem to be a family behaviour. In fact, almost all families admit to consume at least one meal a week at a fast-food restaurant.

Quite paradoxically, the diagnosis of CD could implies notable advantages for these patients. First of all hypo/normo-caloric gluten free diet can benefit of the regularization of the adsorbent surface. When the diagnosis is made at an early age, this can also allow to achieve the growth target and make possible the prevention of complications, such as thyroiditis, diabetes and osteoporosis.

In conclusion our study demonstrate that there are no differences in qualitative and quantitative mistakes in food frequency and in life habits in celiac obese/ overweight children and adolescents at diagnosis compared to the non celiac ones.

 

REFERENCES

  1. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163: 286-292.
  2. Nenna R,Tiberti C, Petrarca L,et al.The celiac Iceberg: A Characterization of the Disease in Primary School Children. J Pediatr Gastroenterol Nutr.2013 Apr;56:416-21.
  3. Nenna R, Mosca A, Mennini M, Papa RE, Petrarca L, Mercurio R, Montuori M, Piedimonte A, Bavastrelli M, De Lucia IC, Bonamico M, Vania A. Celiac disease screening among a large cohort of overweight/obese children. J Pediatr Gastroenterol Nutr. 2015 Mar;60(3):405-7. doi: 10.1097/MPG.0000000000000656.
  4. Murray JA, Van Dyke C, Plevak MF, et al. Trends in the identification and clinical features of celiac disease in a North American Community, 1950 to 2001. Clin Gastroenterol Hepatol 2003; 1: 19-27.
  5. Binkin N, Fontana G, Lamberti A, et al. A national survey of the prevalence of childhood overweight and obesity in Italy. Obesity reviews 2010; 11: 2-10.
  6. Venkatasubramani N, Telega G, Werlin SL. Obesity in pediatric celiac disease. J Pediatr Gastroenterol Nutr 2010; 51: 295-297.
  7. Balamtekin N, Baysoy G, Demir H. Differences in the prevalence of obesity in children with celiac disease. J Pediatr Gastroenterol Nutr 2011; 52: 784.
  8. Reilly NR, Aguilar K, Hassid BG, et al. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr 2011; 53: 528-531.
  9. Szajewska H, Ruszczynski M. Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Crit Rev Food Sci Nutr. 2010;50:113-9

 

 

 

 

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