Cholesterol change in coeliac patients following gluten-free diet depends on baseline levels
2
Please cite this article in press as: Pes GM, et al. Cholesterol change in coeliac patients following gluten-free diet depends on baseline levels. Dig Liver Dis (2014), http://dx.doi.org/10.1016/j.dld.2014.02.015 ARTICLE IN PRESS G Model YDLD-2592; No. of Pages 2 Digestive and Liver Disease xxx (2014) xxx–xxx Contents lists available at ScienceDirect Digestive and Liver Disease jou rnal h om epage: www.elsevier.com/locate/dld Correspondence Cholesterol change in coeliac patients following gluten-free diet depends on baseline levels To the Editor, In their recent paper on Digestive and Liver Disease, Zanini et al. discussed the relevance of a gluten-free diet (GFD) in modifying the cardiovascular (CV) risk of patients with coeliac disease (CD) [1]. Based on the analysis of a large cohort, these authors recognized that “GFD causes significant changes in parameters associated with CV risk” although they concluded that these changes “do not consistently point at a better or worse CV risk profile”. This overcautious assertion was supported by the fact that while HDL cholesterol (HDL-C), triglycerides (TG) and homocysteine improve significantly, others parameters including BMI, total cholesterol (TC) and LDL cholesterol (LDL-C) seem to get worse, as previously reported [2]. However, the authors’ claim that GFD may cause cholesterol levels to rise does not take into account a possible het- erogeneity among CD patients at diagnosis [3]. In a recent retrospective study we evaluated 52 patients (94.2% women; median age 41 years), with biopsy-proven CD and free from primary dyslipidemia or other lipid altering conditions. Writ- ten informed consent was obtained from the subjects and the study was approved by the Ethics Committee of the local Health Author- ity. Patients were advised to adhere strictly for 24 months to a standard GFD (2200 kcal/d for females and 3000 kcal/d for males). Fasting TC, HDL-C and TG were assessed before and after GFD. LDL-C was calculated according to the Friedewald formula, VLDL cholesterol was calculated as the difference between TC and HDL- C + LDL-C. Patients were divided into two subgroups based on base- line LDL-C levels higher or lower than the target value of 100 mg/dl according to NCEP guidelines [4]. Differences between groups were analyzed with the Mann–Whitney U test, and correlation was expressed by Pearson’s r coefficient, with a 5% significance level. Table 1 Changes in lipid parameters before and after gluten-free diet. Lipid parameters Mean before (SD) Mean after (SD) % before–after P-value a LDL-C before < 100 mg/dl LDL-C before ≥ 100 mg/dl TC (mg/dl) 181.1 (38.7) 186.0 (39.8) 11.6 −3.7 0.003 HDL-C (mg/dl) 55.1 (15.7) 56.0 (14.8) 5.2 2.7 0.747 TG (mg/dl) 73.6 (34.3) 78.2 (42.8) 12.9 10.9 0.938 LDL-C (mg/dl) 113.6 (38.0) 114.3 (32.3) 20.2 −10.4 0.0001 VLDL-C (mg/dl) 14.4 (7.2) 15.7 (8.5) 12.9 10.2 0.984 HDL-C/LDL-C ratio 0.56 (0.31) 0.53 (0.22) −4.0 16.0 0.082 TC, total cholesterol; HDL-C, high density lipoprotein-cholesterol; TG, triglycerides; LDL-C, low density lipoprotein-cholesterol; VLDL-C, very low density lipoprotein- cholesterol. a Mann–Whitney U test. For the whole sample, no significant differences were observed between pre- and post-GFD lipid parameters. However, LDL-C increased by 20% and decreased by 10% in patient subgroups with initial values below or above 100 mg/dL, respectively (p = 0.0001). A consistent negative correlation (r = −0.566; p = 0.0001) was observed between LDL-C at baseline and the LDL-C difference before and after GFD. TC showed a similar trend, whereas HDL-C, VLDL and TG increased in both subgroups (Table 1). Potential gen- der differences could not be observed due to the small number of males. Our results show that changes in lipid parameters in GFD- treated CD patients are largely dependent on the initial profile. An inverse correlation exists between the initial values of TC and LDL- C and the magnitude of their change. The overall treatment impact is to stabilize the lipid profile at near normal range, thus potentially reducing CV risk. Although untreated CD is usually associated with low TC levels, a subgroup of patients with non-classic presentations and without primary dyslipidemia, such as adults with hypochromic anaemia [5] or with minimal malabsorption, may display mild/moderate hypercholesterolemia at diagnosis, when a concomitant excess intake of dietary fat occurs. A strictly followed GFD implies close control of patient’s eating habits with the unintentional result that, as well as reducing gut inflammation and malabsorption, a coex- isting dietary imbalance may be corrected. Thus, it is likely that in newly diagnosed patients displaying overt hypocholesterolemia, the effect of GFD is to increase cholesterol level via enhanced intestinal uptake and reduced steatorrhea. However, in the subset of CD patients whose cholesterol level is increased due to unhealthy eating habits, GFD may lower it even before the effects of increased intestinal absorption become apparent. This hypothesis should be examined in a larger clinical study. We believe that the concern about increased cardiovascular risk in patients following GFD is currently overemphasized. http://dx.doi.org/10.1016/j.dld.2014.02.015 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
-
Upload
maria-pina -
Category
Documents
-
view
214 -
download
1
Transcript of Cholesterol change in coeliac patients following gluten-free diet depends on baseline levels
Y
C
Cg
T
dcBtwnocs(rce
wftwisFLcClaae
TC
Tc
h1
ARTICLE IN PRESSG ModelDLD-2592; No. of Pages 2
Digestive and Liver Disease xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Digestive and Liver Disease
jou rna l h om epage: www.elsev ier .com/ locate /d ld
intestinal absorption become apparent. This hypothesis should beexamined in a larger clinical study. We believe that the concern
orrespondence
holesterol change in coeliac patients followingluten-free diet depends on baseline levels
o the Editor,
In their recent paper on Digestive and Liver Disease, Zanini et al.iscussed the relevance of a gluten-free diet (GFD) in modifying theardiovascular (CV) risk of patients with coeliac disease (CD) [1].ased on the analysis of a large cohort, these authors recognizedhat “GFD causes significant changes in parameters associatedith CV risk” although they concluded that these changes “doot consistently point at a better or worse CV risk profile”. Thisvercautious assertion was supported by the fact that while HDLholesterol (HDL-C), triglycerides (TG) and homocysteine improveignificantly, others parameters including BMI, total cholesterolTC) and LDL cholesterol (LDL-C) seem to get worse, as previouslyeported [2]. However, the authors’ claim that GFD may causeholesterol levels to rise does not take into account a possible het-rogeneity among CD patients at diagnosis [3].
In a recent retrospective study we evaluated 52 patients (94.2%omen; median age 41 years), with biopsy-proven CD and free
rom primary dyslipidemia or other lipid altering conditions. Writ-en informed consent was obtained from the subjects and the studyas approved by the Ethics Committee of the local Health Author-
ty. Patients were advised to adhere strictly for 24 months to atandard GFD (2200 kcal/d for females and 3000 kcal/d for males).asting TC, HDL-C and TG were assessed before and after GFD.DL-C was calculated according to the Friedewald formula, VLDLholesterol was calculated as the difference between TC and HDL-
+ LDL-C. Patients were divided into two subgroups based on base-ine LDL-C levels higher or lower than the target value of 100 mg/dlccording to NCEP guidelines [4]. Differences between groups were
Please cite this article in press as: Pes GM, et al. Cholesterol change inlevels. Dig Liver Dis (2014), http://dx.doi.org/10.1016/j.dld.2014.02.01
nalyzed with the Mann–Whitney U test, and correlation wasxpressed by Pearson’s r coefficient, with a 5% significance level.
able 1hanges in lipid parameters before and after gluten-free diet.
Lipid parameters Meanbefore (SD) Meanafter (SD)
TC (mg/dl) 181.1 (38.7) 186.0 (39.8)
HDL-C (mg/dl) 55.1 (15.7) 56.0 (14.8)
TG (mg/dl) 73.6 (34.3) 78.2 (42.8)
LDL-C (mg/dl) 113.6 (38.0) 114.3 (32.3)
VLDL-C (mg/dl) 14.4 (7.2) 15.7 (8.5)
HDL-C/LDL-C ratio 0.56 (0.31) 0.53 (0.22)
C, total cholesterol; HDL-C, high density lipoprotein-cholesterol; TG, triglycerides; LDholesterol.
a Mann–Whitney U test.
ttp://dx.doi.org/10.1016/j.dld.2014.02.015590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All
For the whole sample, no significant differences were observedbetween pre- and post-GFD lipid parameters. However, LDL-Cincreased by 20% and decreased by 10% in patient subgroups withinitial values below or above 100 mg/dL, respectively (p = 0.0001).A consistent negative correlation (r = −0.566; p = 0.0001) wasobserved between LDL-C at baseline and the LDL-C differencebefore and after GFD. TC showed a similar trend, whereas HDL-C,VLDL and TG increased in both subgroups (Table 1). Potential gen-der differences could not be observed due to the small number ofmales.
Our results show that changes in lipid parameters in GFD-treated CD patients are largely dependent on the initial profile. Aninverse correlation exists between the initial values of TC and LDL-C and the magnitude of their change. The overall treatment impactis to stabilize the lipid profile at near normal range, thus potentiallyreducing CV risk.
Although untreated CD is usually associated with low TC levels,a subgroup of patients with non-classic presentations and withoutprimary dyslipidemia, such as adults with hypochromic anaemia[5] or with minimal malabsorption, may display mild/moderatehypercholesterolemia at diagnosis, when a concomitant excessintake of dietary fat occurs. A strictly followed GFD implies closecontrol of patient’s eating habits with the unintentional result that,as well as reducing gut inflammation and malabsorption, a coex-isting dietary imbalance may be corrected. Thus, it is likely that innewly diagnosed patients displaying overt hypocholesterolemia,the effect of GFD is to increase cholesterol level via enhancedintestinal uptake and reduced steatorrhea. However, in the subsetof CD patients whose cholesterol level is increased due to unhealthyeating habits, GFD may lower it even before the effects of increased
coeliac patients following gluten-free diet depends on baseline5
�%before–after P-valuea
LDL-Cbefore < 100 mg/dl LDL-Cbefore ≥ 100 mg/dl
11.6 −3.7 0.0035.2 2.7 0.747
12.9 10.9 0.93820.2 −10.4 0.000112.9 10.2 0.984−4.0 16.0 0.082
L-C, low density lipoprotein-cholesterol; VLDL-C, very low density lipoprotein-
about increased cardiovascular risk in patients following GFD iscurrently overemphasized.
rights reserved.
ING ModelY
2 d Live
R
[
[
[
[
[E-mail address: [email protected]
(G.M. Pes)
ARTICLEDLD-2592; No. of Pages 2
Correspondence / Digestive an
eferences
1] Zanini B, Mazzoncini E, Lanzarotto F, et al. Impact of gluten-free diet on cardio-vascular risk factors: a retrospective analysis in a large cohort of coeliac patients.Dig Liver Dis 2013;45:810–5.
2] Norsa L, Shamir R, Zevit N. Gluten-free diet in coeliac disease: protective orproviding additive risk factors for the development of cardiovascular disease.Nutr Ther Metab 2012;30:1–9.
3] Brar P, Kwon GY, Holleran S, et al. Change in lipid profile in celiac disease:beneficial effect of gluten-free diet. Am J Med 2006;119:786–90.
4] National Cholesterol Education Program: Third report of the expert panel ondetection, evaluation and treatment of high blood cholesterol in adults (adulttreatment panel III). NIH publication No. 01-3670. Department of Health andHuman Services, National Institutes of Health, NHLBI; 2001.
5] Ciacci C, Cirillo M, Giorgetti G, et al. Low plasma cholesterol: a correlate of nondi-agnosed celiac disease in adults with hypochromic anemia. Am J Gastroenterol1999;94:1888–91.
Please cite this article in press as: Pes GM, et al. Cholesterol change inlevels. Dig Liver Dis (2014), http://dx.doi.org/10.1016/j.dld.2014.02.01
Giovanni Mario Pes ∗
Department of Clinical and Experimental Medicine,University of Sassari, Italy
PRESSr Disease xxx (2014) xxx–xxx
Francesco ToluEndocrinology Unit, AOU Sassari, Italy
Monica BazzuMaria Pina Dore
Department of Clinical and Experimental Medicine,University of Sassari, Italy
∗ Corresponding author at: Dipartimento diMedicina Clinica e Sperimentale, Viale San Pietro 8,
I-07100 Sassari, Italy. Tel.: +39 347 45 39 532;fax: +39 079 22 82 40.
coeliac patients following gluten-free diet depends on baseline5
Available online xxx
