title: Refractory celiac disease and EATL patients show severe malnutrition and malabsorption at diagnosis.
abstract: Refractory celiac disease type II (RCDII) and EATL (Enteropathy Associated T-cell Lymphoma) are (pre)malignant complications of celiac disease (CD). Data on malnutrition and intestinal absorption is lacking in these patients. Therefore, the aim of the study is to comprehensively assess nutritional status and intestinal absorption capacity of patients with RCDII and EATL, compared with data of newly diagnosed CD patients.
  
  
  
  Observational study in tertiary care setting in RCDII (n = 24, 63.8 ± 8.2 y), EATL (n = 25, 62.3 ± 5.7 y) and CD patients (n = 43, 45.6 ± 14.8 y). At diagnosis, anthropometry (BMI, unintentional weight loss, fat-free mass index (FFMI), handgrip strength (HGS), nutritional intake, fecal losses and Resting Energy Expenditure (REE)) were assessed.
  
  
  
  Low BMI (<18.5) was more often observed in RCDII patients than in CD or EATL patients (in 33%, 12% and 12%, respectively, p = 0.029). EATL patients more frequently had unintentional weight loss (>10%) than CD or RCDII patients (in 58%, 19% and 39% of patients, respectively; p = 0.005/0.082). Energy malabsorption (<85%) was detected in 44% and 33% of RCDII and EATL patients, vs 21.6% in CD (NS). Fecal energy losses were higher in RCDII than in CD patients (589 ± 451 vs 277 ± 137 kcal/d, p = 0.017). REE was underestimated by predicted-REE with>10% in 60% of RCDII, 89% of EATL, and 38% of CD patients (p = 0.006). Low FFMI and HGS were detected in one third and two thirds of all patients, respectively.
  
  
  
  The nutritional status of patients with RCDII and EATL is inferior compared with untreated naïve CD patients at presentation. Both malabsorption as well as hypermetabolism contribute to malnutrition.
authors.affiliation: Department of Nutrition and Dietetics, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: N.Wierdsma@vumc.nl.
authors.forename: Nicolette J
authors.initials: NJ
authors.lastname: Wierdsma
authors.affiliation: Department of Gastroenterology, Celiac Centre Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: P.Nijeboer@vumc.nl.
authors.forename: Petula
authors.initials: P
authors.lastname: Nijeboer
authors.affiliation: Department of Nutrition and Dietetics, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: M.devanderSchueren@vumc.nl.
authors.forename: Marian A E
authors.initials: MA
authors.lastname: de van der Schueren
authors.affiliation: Department of Nutrition and Dietetics, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: M.Berkenpas@vumc.nl.
authors.forename: Marijke
authors.initials: M
authors.lastname: Berkenpas
authors.affiliation: Department of Gastroenterology, Celiac Centre Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands; Department of Internal Medicine, Gastroenterology and Geriatrics, ATRIUM-ORBIS Medical Centre, PO Box 5500, 6130 MB, Sittard, The Netherlands. Electronic address: v.Bodegraven@vumc.nl.
authors.forename: Ad A
authors.initials: AA
authors.lastname: van Bodegraven
authors.affiliation: Department of Gastroenterology, Celiac Centre Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: cjmulder@vumc.nl.
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002446:Celiac Disease / Q000503:physiopathology* / Q000628:therapy; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002149:Energy Intake; D004734:Energy Metabolism; D058527:Enteropathy-Associated T-Cell Lymphoma / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008286:Malabsorption Syndromes / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009752:Nutritional Status; D010044:Outpatient Clinics, Hospital; D011230:Precancerous Conditions / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D015995:Prevalence; D012720:Severity of Illness Index; D013851:Thinness / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology
keywords: Anthropometrics; Complicated celiac disease; Enteropathy-associated T-cell lymphoma; Fecal losses; Malnutrition; Nutritional status