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Review
. 2023 Mar 19;15(6):1475.
doi: 10.3390/nu15061475.

Nutritional Considerations in Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity

Fardowsa Abdi  1 , Saania Zuberi  1 , Jedid-Jah Blom  1 , David Armstrong  1 , Maria Ines Pinto-Sanchez  1
Affiliations
Review

Nutritional Considerations in Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity

Fardowsa Abdi et al. Nutrients. .

Abstract

A gluten-free diet (GFD) is the only available treatment for celiac disease (CeD), and it may also improve symptoms in non-celiac gluten/wheat sensitivity (NCGWS). In CeD, gluten triggers an immune reaction leading to enteropathy, malabsorption, and symptoms; in NCGWS, the mechanism leading to symptoms is unknown, and neither wheat nor gluten triggers enteropathy or malabsorption. A strict GFD is, therefore, necessary for CeD, but a gluten-restricted diet (GRD) may suffice to achieve symptom control for NCGWS. Regardless of this distinction, the risk of malnutrition and macro- and micronutrient deficiencies is increased by the adoption of a GFD or GRD. Thus, patients with CeD or NCGWS should undergo nutritional assessment and subsequent monitoring, based on evidence-based tools, under the care of a multidisciplinary team involving physicians and dietitians, for the long-term management of their nutrition. This review gives an overview of available nutrition assessment tools and considerations for the nutritional management of CeD and NCGWS populations.

Keywords: celiac disease; gluten; nutrition assessment; wheat sensitivity.

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Conflict of interest statement

MI Pinto-Sanchez received honoraria from Takeda for consulting and research funding from ProventBio, unrelated to this manuscript. D Armstrong has received honoraria from Takeda and Fresenius-Kabi for consulting, presentations, and research funding from Nestlé Health Sciences Canada.

Figures

Figure 1
Figure 1
The components required in nutritional assessment to determine nutritional status in patients with celiac disease (CeD) and non-celiac gluten/wheat sensitivity (NCGWS). * Anthropometrics: height, weight, body circumferences (waist, hip, and limbs), and skinfold thickness.
Figure 2
Figure 2
Heat, carbon dioxide (CO2), and oxygen (O2) released by food combustion can be measured by direct or indirect calorimetry to determine energy expenditure [56].
Figure 3
Figure 3
Macro- and micronutrient imbalance associated with a gluten-free diet (GFD). * Micro and micronutrients.
Figure 4
Figure 4
Algorithm for the nutritional assessment and management in patients with CeD and NCGWS. * Experts recommend nutrition follow-up during regular visits, usually every 6 months in the first year and then annually. The frequency of follow-up visits will be determined by nutritional status, with more frequent visits in malnourished patients.
See this image and copyright information in PMC

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