Adults With Celiac Disease May Be at Risk of Atherosclerosis
Adults With Celiac Disease May Be at Risk of Atherosclerosis
Twenty patients (11 females, age range 23–41 years) agreed to take part in the study. Reasons for the referral were: unexplained anaemia (six patients), irritable bowel syndrome unresponsive to conventional treatment (four patients), severe functional dyspepsia (four patients) and chronic diarrhoea (six patients). One coeliac patient was diagnosed as affected by Hashimoto thyroiditis, but no other immune disorders, diabetes mellitus included, were present in this group of patients. We decided to include patient/s where an immune disorder was found on diagnostic work-up to decrease potential selection bias. One patient was currently smoking approximately 20 cigarettes per day, while the others were no-smokers. Four patients reported familiarity for cardiovascular diseases, two for stroke, five for hypertension, while no vascular-related familiar risk was reported by the remaining nine patients. Blood pressure and electrocardiogram (12 derivations) were normal in all subjects. The presumed diagnosis of coeliac disease was first confirmed by histology in all subjects. Fifteen patients showed features of partial villous atrophy (Marsh IIIA), while subtotal–total villous atrophy was evident in the remaining five (Marsh IIIB-C). After gluten abstinence, repeat small bowel biopsy showed a normal duodenal histology in all patients, but one in which a Marsh I lesion was described (normal mucosal architecture and increased intraepithelial lymphocytes ≥40/100 enterocytes).
Only two patients were underweight (BMI = 17.9), while all other subjects showed BMI within normal range (mean BMI 20.51, range 17.9–22.9). BMI increased significantly on gluten withdrawal (mean BMI 21.07, range 18.9–23.2) compared with baseline (P < 0.03). At baseline evaluation, mean total plasma cholesterol and mean HDL cholesterol concentration were both within normal limits, while mean LDL cholesterol concentration was slightly out of the normal range (110.73 ± 24.65 mg/dL reference range <100 mg/dL, Table 1). Compared with baseline, gluten abstinence was associated with a significant increment in both total plasma cholesterol and HDL plasma cholesterol concentrations (P < 0.03 and P < 0.001, respectively), while LDL cholesterol concentration remained unaffected (Table 1). As a consequence, the total cholesterol/HDL ratio was significantly improved by gluten withdrawal (3.05 ± 0.71 vs. 3.77 ± 0.92 ratio, reference range >4; P < 0.02). On the contrary, plasma triglyceride concentration was within normal range in all patients and not influenced by gluten withdrawal (Table 1). CRP was also significantly decreased on gluten-free diet (P < 0.05 – Table 1). At baseline, mean plasma homocysteine was superior to normal range for our laboratory (18.94 ± 7.35 μmol/L; reference range <15 μmol/L). However, gluten abstinence was associated with a nonsignificant decrease in homocysteine concentration and both folate and vitamin B12 concentration remained unaffected as well (Table 1).
Blood pressure and heart rate did not change throughout the study and no difference was found between groups (Table 2). QIMT was significantly increased in the coeliac group compared with the controls (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005). Gluten-free diet was associated with a significant decrease in QIMT in coeliacs (0.064 ± 0.010 vs. 0.082 ± 0.011 cm; P < 0.03). EDD was reduced in coeliac patients compared with the controls (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05) and it recovered after dietetic intervention (12.1 ± 2.3 vs. 9.3 ± 1.3%; P = 0.05 – Figure 1).
(Enlarge Image)
Figure 1.
Intima-media thickness in 20 coeliacs at disease diagnosis (CD baseline) and in 22 controls; additional testing was performed in coeliacs after 6–8 months of gluten-free diet (*P < 0.005 coeliacs vs. controls; **P < 0.03 gluten-free coeliacs vs. baseline coeliacs).
Results
Twenty patients (11 females, age range 23–41 years) agreed to take part in the study. Reasons for the referral were: unexplained anaemia (six patients), irritable bowel syndrome unresponsive to conventional treatment (four patients), severe functional dyspepsia (four patients) and chronic diarrhoea (six patients). One coeliac patient was diagnosed as affected by Hashimoto thyroiditis, but no other immune disorders, diabetes mellitus included, were present in this group of patients. We decided to include patient/s where an immune disorder was found on diagnostic work-up to decrease potential selection bias. One patient was currently smoking approximately 20 cigarettes per day, while the others were no-smokers. Four patients reported familiarity for cardiovascular diseases, two for stroke, five for hypertension, while no vascular-related familiar risk was reported by the remaining nine patients. Blood pressure and electrocardiogram (12 derivations) were normal in all subjects. The presumed diagnosis of coeliac disease was first confirmed by histology in all subjects. Fifteen patients showed features of partial villous atrophy (Marsh IIIA), while subtotal–total villous atrophy was evident in the remaining five (Marsh IIIB-C). After gluten abstinence, repeat small bowel biopsy showed a normal duodenal histology in all patients, but one in which a Marsh I lesion was described (normal mucosal architecture and increased intraepithelial lymphocytes ≥40/100 enterocytes).
Only two patients were underweight (BMI = 17.9), while all other subjects showed BMI within normal range (mean BMI 20.51, range 17.9–22.9). BMI increased significantly on gluten withdrawal (mean BMI 21.07, range 18.9–23.2) compared with baseline (P < 0.03). At baseline evaluation, mean total plasma cholesterol and mean HDL cholesterol concentration were both within normal limits, while mean LDL cholesterol concentration was slightly out of the normal range (110.73 ± 24.65 mg/dL reference range <100 mg/dL, Table 1). Compared with baseline, gluten abstinence was associated with a significant increment in both total plasma cholesterol and HDL plasma cholesterol concentrations (P < 0.03 and P < 0.001, respectively), while LDL cholesterol concentration remained unaffected (Table 1). As a consequence, the total cholesterol/HDL ratio was significantly improved by gluten withdrawal (3.05 ± 0.71 vs. 3.77 ± 0.92 ratio, reference range >4; P < 0.02). On the contrary, plasma triglyceride concentration was within normal range in all patients and not influenced by gluten withdrawal (Table 1). CRP was also significantly decreased on gluten-free diet (P < 0.05 – Table 1). At baseline, mean plasma homocysteine was superior to normal range for our laboratory (18.94 ± 7.35 μmol/L; reference range <15 μmol/L). However, gluten abstinence was associated with a nonsignificant decrease in homocysteine concentration and both folate and vitamin B12 concentration remained unaffected as well (Table 1).
Blood pressure and heart rate did not change throughout the study and no difference was found between groups (Table 2). QIMT was significantly increased in the coeliac group compared with the controls (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005). Gluten-free diet was associated with a significant decrease in QIMT in coeliacs (0.064 ± 0.010 vs. 0.082 ± 0.011 cm; P < 0.03). EDD was reduced in coeliac patients compared with the controls (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05) and it recovered after dietetic intervention (12.1 ± 2.3 vs. 9.3 ± 1.3%; P = 0.05 – Figure 1).
(Enlarge Image)
Figure 1.
Intima-media thickness in 20 coeliacs at disease diagnosis (CD baseline) and in 22 controls; additional testing was performed in coeliacs after 6–8 months of gluten-free diet (*P < 0.005 coeliacs vs. controls; **P < 0.03 gluten-free coeliacs vs. baseline coeliacs).
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