Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study

Antonio Carroccio, Maurizio Soresi, Alberto D'Alcamo, Carmelo Sciumè, Giuseppe Iacono, Girolamo Geraci, Ignazio Brusca, Aurelio Seidita, Floriana Adragna, Miriam Carta, Pasquale Mansueto, Antonio Carroccio, Maurizio Soresi, Alberto D'Alcamo, Carmelo Sciumè, Giuseppe Iacono, Girolamo Geraci, Ignazio Brusca, Aurelio Seidita, Floriana Adragna, Miriam Carta, Pasquale Mansueto

Abstract

Background: Non-celiac gluten sensitivity (NCGS) or 'wheat sensitivity' (NCWS) is included in the spectrum of gluten-related disorders. No data are available on the prevalence of low bone mass density (BMD) in NCWS. Our study aims to evaluate the prevalence of low BMD in NCWS patients and search for correlations with other clinical characteristics.

Methods: This prospective observation study included 75 NCWS patients (63 women; median age 36 years) with irritable bowel syndrome (IBS)-like symptoms, 65 IBS and 50 celiac controls. Patients were recruited at two Internal Medicine Departments. Elimination diet and double-blind placebo controlled (DBPC) wheat challenge proved the NCWS diagnosis. All subjects underwent BMD assessment by Dual Energy X-Ray Absorptiometry (DXA), duodenal histology, HLA DQ typing, body mass index (BMI) evaluation and assessment for daily calcium intake.

Results: DBPC cow's milk proteins challenge showed that 30 of the 75 NCWS patients suffered from multiple food sensitivity. Osteopenia and osteoporosis frequency increased from IBS to NCWS and to celiac disease (CD) (P <0.0001). Thirty-five NCWS patients (46.6%) showed osteopenia or osteoporosis. Low BMD was related to low BMI and multiple food sensitivity. Values of daily dietary calcium intake in NCWS patients were significantly lower than in IBS controls.

Conclusions: An elevated frequency of bone mass loss in NCWS patients was found; this was related to low BMI and was more frequent in patients with NCWS associated with other food sensitivity. A low daily intake of dietary calcium was observed in patients with NCWS.

Figures

Figure 1
Figure 1
Individual and mean ±95% c.i. (bars) values of lumbar (a) and femoral (b) BMD in the three study groups, expressed in absolute values (g/cm2). BMD, bone mass density; c.i., confidence interval.
Figure 2
Figure 2
Percentage of the patients of the three groups who had normal BMD, osteopenia or osteoporosis, evaluated both at the lumbar spine and femoral neck. The frequency of osteopenia and osteoporosis was significantly different in the three groups, increasing from IBS to NCWS, and to CD patients (P <0.0001, Spearman’s rank correlation). BMD, bone mass density; CD, celiac disease; IBS, irritable bowel syndrome; NCWS, non-celiac wheat sensitivity.
Figure 3
Figure 3
Individual values of BMD, expressed as absolute values (g/cm2), in relation to the BMI, both at the femoral neck (Panel a) and at the lumbar spine (Panel b). A significant direct correlation between the individual values of BMD (g/cm2) and the BMI values (P <0.0001) has been proved. BMD, bone mass density; BMI, body mass index.

References

    1. Corazza GR, Di Sario A, Cecchetti L, Tarozzi C, Corrao G, Bernardi M, Gasbarrini G. Bone mass and metabolism in patients with coeliac disease. Gastroenterology. 1995;109:122–128. doi: 10.1016/0016-5085(95)90276-7.
    1. Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, Kaukinen K, Rostami K, Sanders DS, Schumann M, Ullrich R, Villalta D, Volta U, Catassi C, Fasano A. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13. doi: 10.1186/1741-7015-10-13.
    1. Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A. Fasano: non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients. 2013;5:3839–3853. doi: 10.3390/nu5103839.
    1. Carroccio A, Mansueto P, Iacono G, Soresi M, D'Alcamo A, Cavataio F, Brusca I, Florena AM, Ambrosiano G, Seidita A, Pirrone G, Rini GB. Non-celiac wheat sensitivity diagnosed by double-blind placebo controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 2012;107:1898–1906. doi: 10.1038/ajg.2012.236.
    1. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45:43–47.
    1. Rostami K, Kerckhaert J, Tiemessen R, von Blomberg BM, Meijer JW, Mulder CJ. Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice. Am J Gastroenterol. 1999;94:888–894. doi: 10.1111/j.1572-0241.1999.983_f.x.
    1. Carroccio A, Montalto G, Cavera G, Notarbatolo A. Lactose intolerance and self-reported milk intolerance: relationship with lactose maldigestion and nutrient intake. J Am Coll Nutr. 1998;17:631–636. doi: 10.1080/07315724.1998.10718813.
    1. Istituto Nazionale della Nutrizione (Italian Institute for Nutrition): Food Composition Tables. Rome: ᅟ; 1986.
    1. Mooney PD, Aziz I, Sanders DS. Non-celiac gluten sensitivity: clinical relevance and recommendations for future research. Neurogastroenterol Motil. 2013;25:864–871. doi: 10.1111/nmo.12216.
    1. Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145:320–328. doi: 10.1053/j.gastro.2013.04.051.
    1. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146:67–75. doi: 10.1053/j.gastro.2013.09.046.
    1. Junker Y, Zeissig S, Kim SJ, Barisani D, Wieser H, Leffler DA, Zevallos V, Libermann TA, Dillon S, Freitag TL, Kelly CP, Schuppan D. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med. 2012;209:2395–2408. doi: 10.1084/jem.20102660.
    1. Carroccio A, Mansueto P, D'Alcamo A, Iacono G. Non-celiac wheat sensitivity as an allergic condition: personal experience and narrative review. Am J Gastroenterol. 2013;108:1845–1852. doi: 10.1038/ajg.2013.353.
    1. Carroccio A, Rini G, Mansueto P. Non-celiac wheat sensitivity is a more appropriate label than non-celiac gluten sensitivity. Gastroenterology. 2014;146:320–321. doi: 10.1053/j.gastro.2013.08.061.
    1. Aziz I, Lewis NR, Hadjivassiliou M, Winfield SN, Rugg N, Kelsall A, Newrick L, Sanders DS. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol. 2014;26:33–39. doi: 10.1097/01.meg.0000435546.87251.f7.
    1. 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;48:921–925. doi: 10.3109/00365521.2013.809598.
    1. Ciacci C, Bucci C, Zingone F, Fortunato A, Napoli M, Morra A, Iovino P. What non celiac gluten sensitive patients do not eat (beside gluten) Chicago: 15th International Celiac Disease Symposium; 2013. p. 61.
    1. Tavakkoli A, Lewis SK, Tennyson CA, Lebwohl B, Green PH. Characteristics of patients who avoid wheat and/or gluten in the absence of Celiac disease. Dig Dis Sci. 2014;59:1255–1261. doi: 10.1007/s10620-013-2981-6.
    1. Volta U, Bardella MT, Calabrò A, Troncone R, Corazza GR. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med. 2014;12:85. doi: 10.1186/1741-7015-12-85.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel