title: Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease.
abstract: OBJECTIVE
  Children with celiac disease (CD) are at risk for decreased bone mineral density (BMD) because of fat-soluble vitamin malabsorption, inflammation and/or under-nutrition. The study objective was to determine the interrelationships between vitamin K/D status and lifestyle variables on BMD in children and adolescents with CD at diagnosis and after 1 year on the gluten-free diet (GFD).
  
  
  METHODS
  Children and adolescents aged 3-17 years with biopsy proven CD at diagnosis and after 1 year on the GFD were studied. BMD was measured using dual-energy X-ray absorptiometry. Relevant variables included: anthropometrics, vitamin D/K status, diet, physical activity and sunlight exposure.
  
  
  RESULTS
  Whole-body and lumbar-spine BMD-z scores were low (< or = -1) at diagnosis (10-20%) and after 1 year (30-32%) in the children, independent of symptoms. Whole-body BMD-z scores (-0.55±0.7 versus 0.72±1.5) and serum levels of 25(OH) vitamin D (90.3±24.8 versus 70.5±19.8 nmol/l) were significantly lower in older children (>10 years) when compared with younger children (< or =10 years) (P<0.001). Forty-three percent had suboptimal vitamin D status (25(OH)-vitamin D <75 nmol/l) at diagnosis; resolving in nearly half after 1 year on the GFD. Twenty-five percent had suboptimal vitamin K status at diagnosis; all resolved after 1 year.
  
  
  CONCLUSIONS
  Children and adolescents with CD are at risk for suboptimal bone health at time of diagnosis and after 1 year on GFD; likely due in part to suboptimal vitamin D/K status. Therapeutic strategies aimed at optimizing vitamin K/D intake may contribute to improved BMD in children with CD.
authors.affiliation: Department of Agriculture, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada. mager@ualberta.ca
authors.forename: D R
authors.initials: DR
authors.lastname: Mager
authors.forename: J
authors.initials: J
authors.lastname: Qiao
authors.forename: J
authors.initials: J
authors.lastname: Turner
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000886:Anthropometry; D015415:Biomarkers; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology; D002446:Celiac Disease / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000187:drug effects; D008297:Male; D009043:Motor Activity; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood*; D014812:Vitamin K / Q000008:administration & dosage / Q000097:blood*; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood*
chemical_list: D015415:Biomarkers; D014815:Vitamins; D014812:Vitamin K; D014807:Vitamin D