Subclinical coeliac disease: an anthropometric assessment.
OBJECTIVE
To evaluate the prevalence of malnutrition in patients with untreated coeliac disease (CD) according to their pattern of presentation, and the effect of gluten-free diet (GFD) upon nutritional status.


METHODS
Cohort prospective study.


METHODS
All subjects were seen at the outpatient 'malabsorption' clinic of the Department of Medical Pathology I, University of Bologna (referral centre), Bologna.


METHODS
Eighty consecutive patients with CD (48 with classical and 32 with subclinical presentation), 15 patients with dermatitis herpetiformis (DH) and 40 healthy volunteers (members of the hospital staff).


METHODS
The nutritional status was evaluated by anthropometric measurements (percentage of ideal body weight for height and sex, percentage of standard triceps skinfold thickness and percentage of ideal arm-muscle circumference).


RESULTS
The overall prevalence of malnutrition in our series of CD patients was 53%. Prevalence of malnutrition (actual body weight less than 90% of the ideal) was significantly higher in classical coeliacs (67%) than in subclinical ones (31%, P < 0.002), in patients with DH (13%, P < 0.0003) and in healthy volunteers (13%, P < 0.0001). At diagnosis, percentage values of ideal body weight, triceps skinfold thickness and arm-muscle circumference were significantly lower (P < 0.0001, P < 0.0002 and P < 0.0003, respectively) in classical coeliacs (84.5 +/- 10.6, 71.2 +/- 28.1 and 87.1 +/- 10.8, respectively) than in subclinical coeliacs (95.5 +/- 9.1, 105.6 +/- 41.0 and 94.8 +/- 10.6, respectively). After GFD, 33% of classical and only 3% of subclinical coeliacs were still malnourished.


CONCLUSIONS
Prevalence of malnutrition in CD is lower than was previously thought. CD patients with classical presentation may require a longer period of GFD to achieve a significant improvement of their nutritional status, with respect to those with subclinical presentation, probably because of a greater extent of intestinal damage. Finally, a careful evaluation of dietary habits is usually sufficient to identify incomplete adherence to GFD as the reason for nonimprovement of the nutritional status in patients with CD.
Corazza
G R
GR
Department of Medical Pathology I, University of Bologna, Italy.
Di Sario
A
A
Sacco
G
G
Zoli
G
G
Treggiari
E A
EA
Brusco
G
G
Gasbarrini
G
G
D000328:Adult; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D009752:Nutritional Status / Q000502:physiology*; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D012885:Skinfold Thickness