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LETTER TO THE EDITOR |
Department of Food and Nutrition
Umeå University
Umeå Sweden
E-mail: agneta.hornell{at}kost.umu.se
Dear Sir:
In their recent article in the Journal, Murray et al (1) presented the results of a follow-up study of the effects of a gluten-free diet on both typical and atypical gastrointestinal symptoms related to celiac disease. The effects are presented as if they had occurred within 6 mo of the intervention, which would have been very rapid. However, I have several concerns about the presentation of some of the results.
First, in the Methods section, it is stated that questions were asked about the situation "
6 mo after the start of a gluten-free diet." In the Results section, the "" is dropped, and the wording is "6 mo after starting a gluten-free diet." Were the interviews retrospective—ie, asking about the situation 6 mo after the start of the gluten-free diet—or cross-sectional—ie, asking about the situation at the time of follow-up (which for subjects with a new diagnosis would be 6 mo after the start of a gluten-free diet and for those diagnosed at the earliest time would be 
14 y after the start of a gluten-free diet)?
Second, also in Results, the authors state, "Ninety-one patients gained weight between the time of diagnosis and 6 mo after starting a gluten-free diet, and the weight gain ranged from 0.5 to 46 kg (average of 7.5 kg). In the same period, 25 patients lost an average of 12.5 kg (range: 1–63 kg)." Both gaining 46 kg and losing 63 kg within a space of 6 mo seems unrealistic. There appeared to be no consideration of the age of the subjects (range: 1–90 y at diagnosis) or of the fact that, at the time of the study, 13–14 y had passed since diagnosis (and most likely also since the start of a gluten-free diet) for some of the subjects. Gaining 46 kg between the ages of 1 and 14 y is not remarkable and might not be wholly attributable to the effect of the diet.
Third, body mass index (BMI; in kg/m2) is given as median (±SEM) in the text (p 670) and as mean (±SD) in Table 1, which is very confusing. In addition, SEM should not be used together with median values.
Fourth, it is not clear whether the patients were diagnosed from 1990 through 1997 (as stated in the abstract), between 1984 and 1998 (as stated in the Methods section, p 669), or between 1984 and 1997 (as stated in the Methods section, p 670).
I believe that these faults should have been spotted by the referees, and the authors should have been given a chance to rewrite their manuscript, but unfortunately this was not done.
The article has already been cited in the Minerva section of the journal BMJ (2), where it is written, "As many people present atypically with coeliac disease as present with the more classical triad of steatorrhoea, diarrhoea, and weight loss. A long follow up of a cohort of patients already diagnosed as having coeliac disease and put on a gluten-free diet shows that the diet substantially and rapidly improved all the gastrointestinal symptoms previously reported, not just the typical ones. The authors point out, however, that their cohort was a highly motivated group, which included few teenagers."
ACKNOWLEDGMENTS
The author had no conflicts of interest.
REFERENCES
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