Clinical Practice in Pediatrics

Nutritional status of children on a long-term gluten-free diet

The objective. To study the nutritional status and levels of some nutrients in children and adolescents who received gluten-free diet (GFD) for a long time, and also the informativity of parent questionnaires for screening deficiency conditions.
Patients and methods. We examined 35 children aged 1 to 17 years diagnosed with coeliac disease (n = 23) and gluten hypersensitivity (n = 12), who lived on the territory of the Voronezh region, and also their parents; among them 17 boys and 18 girls. The examined children were distributed into groups as follows: group 1 (n = 14) – aged 1 to 6 years; group 2 (n = 15) – 7 to 12, group 3 (n = 6) – adolescents from 13 to 18 years. Duration of GFD varied from 6 months to 15 years. Anthropometric parameters were assessed, including body mass index; blood tests to determine the levels of vitamins В1, В2, В6, calcium, iron, selenium were performed. Parents were asked to answer the questionnaire specially developed by the authors for screening nutrient deficiency.
Results. Disorder of nutritional status in children and adolescents on a long-term GFD is manifested mainly by decreased body mass index, which was found in 12 (34.4%) patients. Protein-energy deficiency grade 1 was recorded in 3 (8.6%) children, obesity grade 1 – in 1 (2.8%) patient, B6 deficiency – in 5 (14.3%) patients, decrease of ionized calcium – in 14 (40.0%), of serum iron – in 4 (11.4%), anaemia grade 1 – in 2 (5.7%). In all the examined patients, the levels of selenium vitamins B1 and B2 were not changed. Nevertheless, 19 (54.3%), 12 (34.3%), 12 (34.3%) and 11 (37.9%) parents, respectively, answered positively on questions of the questionnaire that characterize group B vitamin deficiency (dyspepsia; stomatites, decreased memory performance; arterial hypertension). Complaints indicative of calcium deficiency were presented by patents of 14 (40%) children, selenium – 11 (29%), iron – 16 (42%). The imbalance between the results of parent questionnaires and laboratory tests might be related not only to possible zinc, vitamin D and copper deficiencies in children but also to parental anxiety about their child’s disease, often associated with the tendency to exaggerate the severity of the condition of the latter.
Conclusion. The above changes of the parameters of nutritional status might be used in rehabilitation of children with gluten intolerance. Questionnaire administration does not reflect the objective picture of the composition of nutrients, since parental complaints significantly exceed the actual number of deficient conditions.
Key words: gluten-free diet, children, gluten intolerance, nutritional status, coeliac disease.
Publisher's imprint: I.A.Bavykina, A.A.Zvyagin. Nutritional status of children on a long-term gluten-free diet. Clinical Practice in Pediatrics. 2015;10(2):20-25.
Received: 14.11.2014