Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets

Abstract

Aim: To describe the cardiovascular disease (CVD) risk factors in a population of children with celiac disease (CD) on a gluten-free diet (GFD).

Methods: This cross-sectional multicenter study was performed at Schneider Children's Medical Center of Israel (Petach Tiqva, Israel), and San Paolo Hospital (Milan, Italy). We enrolled 114 CD children in serologic remission, who were on a GFD for at least one year. At enrollment, anthropometric measurements, blood lipids and glucose were assessed, and compared to values at diagnosis. The homeostasis model assessment-estimated insulin resistance was calculated as a measure of insulin resistance.

Results: Three or more concomitant CVD risk factors [body mass index, waist circumference, low density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and insulin resistance] were identified in 14% of CD subjects on a GFD. The most common CVD risk factors were high fasting triglycerides (34.8%), elevated blood pressure (29.4%), and high concentrations of calculated LDL cholesterol (24.1%). On a GFD, four children (3.5%) had insulin resistance. Fasting insulin and HOMA-IR were significantly higher in the Italian cohort compared to the Israeli cohort (P < 0.001). Children on a GFD had an increased prevalence of borderline LDL cholesterol (24%) when compared to values (10%) at diagnosis (P = 0.090). Trends towards increases in overweight (from 8.8% to 11.5%) and obesity (from 5.3% to 8.8%) were seen on a GFD.

Conclusion: This report of insulin resistance and CVD risk factors in celiac children highlights the importance of CVD screening, and the need for dietary counseling targeting CVD prevention.

Keywords: Cardiovascular disease risk factors; Celiac disease; Children; Cholesterol; Gluten-free diet; Hyperlipidemia; Insulin resistance.

Figure 1

Risk factors for cardiovascular disease in pediatric patients with celiac disease in serological remission on gluten-free diets. White: 0 risk factor; Black: 1 risk factor; Bule: 2 risk factors; Light gray: 3 risk factors; Red: 4 risk factors; Dark gray: 5-6 risk factors. Risk factors sought included BMI Z-scores greater than the 85^th percentile, waist circumference over the 90^th percentile[18], fasting low density lipoprotein cholesterol or triglycerides higher than the 75^th percentile, blood pressure systolic or diastolic greater than the 90^th percentile and insulin resistance[19].