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Changes in body composition, substrate oxidation, and resting metabolic rate in adult celiac disease patients after a 1-y gluten-free diet treatment^1,2

¹ From the Department of Internal Medicine, CNR–Centro Fisiopatologia dello Shock, Università Cattolica del Sacro Cuore, Rome, and the Clinical Diabetes and Nutrition Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.

Background: The incidence of celiac disease has been on the rise in both Europe and the United States. Celiac disease patients are at high risk of undernutrition because of nutrient malabsorption.

Objective: The aim of the present study was to evaluate changes in body composition and energy metabolism in a group of patients with celiac disease before and after consumption of a gluten-free diet (GFD).

Design: Body composition (by anthropometry and isotopic dilution), resting metabolic rate (RMR), and substrate oxidation rates (by indirect calorimetry) were assessed in 39 adult celiac disease patients (16 men and 23 women) with a mean (±SD) age of 29.9 ± 7.6 y, weight of 58.3 ± 6.6 kg, and percentage body fat of 20.1 ± 6.7%, and in 63 (29 men and 34 women) age- and height-matched control subjects (age: 33.2 ± 8.1 y; weight: 66.8 ± 6.6 kg; and percentage body fat: 25.4 ± 3.7%). Celiac disease patients were studied twice, at diagnosis and 1 y after treatment with a GFD.

Results: Before treatment, celiac disease patients had a lower body weight (P < 0.05) and a higher carbohydrate oxidation rate (P < 0.01) than did control subjects. Carbohydrate oxidation rates correlated positively with fecal lipid loss in untreated celiac disease patients (r = 0.80, P < 0.0001). After the GFD, percentage body fat was higher in celiac disease patients than in control subjects (P < 0.01), and lipid intakes tended to be higher than before treatment.

Conclusions: This longitudinal study showed that the GFD treatment significantly increased body fat stores. Untreated patients preferentially utilized carbohydrates as a fuel substrate, probably as a consequence of both lipid malabsorption and a high carbohydrate intake, and lipid utilization increased with the restoration of the intestinal mucosa.

Key Words: Celiac disease • fat mass • fat-free mass • resting metabolic rate • substrate oxidation • body composition • gluten-free diet

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