title: Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5-year longitudinal study from diagnosis.
abstract: BACKGROUND
  Key aims of treatment of coeliac disease are to heal the intestinal mucosa and correct nutritional abnormalities.
  
  
  OBJECTIVE
  We aim to determine prospectively the degree of success and time course of achieving those goals with a gluten-free diet.
  
  
  METHODS
  Ninety-nine patients were enrolled at diagnosis and taught the diet. The first 52 were reassessed at 1 year and 46 at 5 years, 25 being assessed at the three time points regarding dietary compliance (dietitian-assessed), coeliac serology, bone mineral density and body composition analysis by dual energy X-ray absorptiometry, and intestinal histology.
  
  
  RESULTS
  Mean age (range) was 40 (18-71) years and 48 (76%) were female. Dietary compliance was very good to excellent in all but one. Tissue transglutaminase IgA was persistently elevated in 44% at 1 year and 30% at 5 years and were poorly predictive of mucosal disease. Rates of mucosal remission (Marsh 0) and response (Marsh 0/1) were 37% and 54%, and 50% and 85% at 1 and 5 years, respectively. Fat mass increased significantly over the first year in those with normal/reduced body mass index. Lean body mass indices more slowly improved irrespective of status at diagnosis with significant improvement at 5 years. Bone mass increased only in those with osteopenia or osteoporosis, mostly in year 1.
  
  
  CONCLUSIONS
  Dietary compliance is associated with a high chance of healing the intestinal lesion and correction of specific body compositional abnormalities. The time course differed with body fat improving within 1 year, and correction of the mucosal lesion and improvement in lean mass and bone mass taking longer.
authors.affiliation: Department of Gastroenterology and Hepatology, Eastern Health Clinical School.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Newnham
authors.affiliation: Department of Gastroenterology and Hepatology, Eastern Health Clinical School.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Shepherd
authors.affiliation: Body Composition Laboratory, Monash University.
authors.forename: Boyd J
authors.initials: BJ
authors.lastname: Strauss
authors.affiliation: Department of Pathology, Eastern Health.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hosking
authors.affiliation: Department of Gastroenterology, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D050218:Body Fat Distribution; D015992:Body Mass Index; D015519:Bone Density; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000378:metabolism; D055050:Diet, Gluten-Free; D005260:Female; D006040:Goals; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D011503:Transglutaminases / Q000276:immunology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007070:Immunoglobulin A; D011503:Transglutaminases
keywords: body composition; bone mineral density; coeliac disease; histopathology