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Nutrient intakes in adult and pediatric coeliac disease patients on gluten-free diet: a systematic review and meta-analysis

European Journal of Clinical Nutrition volume 77, pages 784–793 (2023)Cite this article

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Abstract

Celiac Disease (CD) continues to require a strict lifetime gluten-free diet (GFD) to maintain healthy status. Many studies have assessed the GFD nutritional adequacy in their cohorts, but an overall picture in adults and children would offer a lifetime vision to identify actionable areas of change. We aimed at assessing the nutrient intakes of adult and pediatric CD patients following a GFD diet and identifying potential areas of improvement. Systematic review was carried out across PubMed, Scopus and Scholar up to October 2022, including full-text studies that assessed the nutrient intakes of CD patients on GFD, in terms of macro- and/or micronutrients (absolute or percentage daily average). Random-effect meta-analysis and univariable meta-regression were applied to obtain pooled estimates for proportions and influencing variables on the outcome, respectively. Thirty-eight studies with a total of 2114 patients were included. Overall, the daily energy intake was 1995 (CI 1884–2106) Kcal with 47.8% (CI 45.7–49.8%) from carbohydrates, 15.5% (CI 14.8–16.2%) from proteins, and 35.8% (CI 34.5–37.0%) from fats. Of total fats, 13.2% (CI 12.4–14.0%) were saturated fats. Teenagers had the highest consumption of fats (94.9, CI 54.8–134.9 g/day), and adults presented insufficient dietary fiber intake (18.9 g, CI 16.5–21.4 g). Calcium, magnesium, and iron intakes were particularly insufficient in adolescence, whereas vitamin D was insufficient in all age groups. In conclusion, GFD may expose CD patients to high fat and low essential micronutrient intakes. Given GFD is a lifelong therapy, to prevent the occurrence of diseases (e.g. cardiovascular or bone disorders) dietary intakes need to be assessed on long-term follow-ups.

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Fig. 1: Main steps of the study.
Fig. 2: Random effect meta-analysis of average daily percentage intakes of macronutrients.
Fig. 3: Random effect meta-analysis of average daily absolute intakes of energy and macronutrients.
Fig. 4: Funnel plot visual inspection of average daily intakes of nutrients.

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Data will be made available upon request.

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Author notes

  1. These authors contributed equally: Monica Gessaroli, Leonardo Frazzoni, Usama Sikandar.

Authors and Affiliations

  1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Monica Gessaroli, Usama Sikandar, Andrea Pession, Rocco Maurizio Zagari, Lorenzo Fuccio & Maria Luisa Forchielli

  2. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Leonardo Frazzoni, Gabriele Bronzetti, Andrea Pession, Rocco Maurizio Zagari, Lorenzo Fuccio & Maria Luisa Forchielli

  3. Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy

    Maria Luisa Forchielli

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Contributions

Concept and design: MG, LFrazzoni and MLF. Analysis and interpretation of the data: MG, LFrazzoni, LFuccio and MLF. Drafting of the article: all authors. Collection and assembly of data: MG, LFrazzoni and US. Critical revision of the article for important intellectual content: all authors. Final approval of the article: all authors.

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Correspondence to Maria Luisa Forchielli.

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Gessaroli, M., Frazzoni, L., Sikandar, U. et al. Nutrient intakes in adult and pediatric coeliac disease patients on gluten-free diet: a systematic review and meta-analysis. Eur J Clin Nutr 77, 784–793 (2023). https://doi.org/10.1038/s41430-023-01280-0

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