Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Celiac disease · Gluten-free diet · Oats · Prevention ·

Gluten-related disorders

Key Messages

• Celiac disease (CD) is an immune-mediated system-
  ic disorder elicited by gluten and related prola-
  mines in genetically susceptible individuals


• CD offers a wide range of clinical presentations
  from severe gastrointestinal symptoms (diarrhea,
  vomiting and failure to thrive) and extraintestinal
  symptoms (iron deficiency anemia, neurological
  problems, alterations in liver function tests, enamel
  defects and osteoporosis) to asymptomatic cases.
  The nutrition status at diagnosis depends mostly on
  the extent of the intestinal damage


• All CD patients should be treated with lifelong glu-
  ten-free diet (GFD) irrespective of symptoms


• An experienced dietician should be involved in or-
  der to evaluate the patient’s current nutritional sta-
  tus, to assess macronutrient and/or micronutrient
  intake, to detect deficiencies, to educate patients to
  the GFD and to monitor dietary compliance


• Alternative therapies and strategies of prevention
  can now be envisaged © 2015 S. Karger AG, Basel

Introduction

Celiac disease (CD) is an immune-mediated sys-

temic disorder elicited by gluten and related pro-

lamines (from wheat, barley and rye) in geneti-

cally susceptible individuals. It is characterized by

the presence of a variable combination of gluten-

dependent clinical manifestations, CD-specific

antibodies [antibodies to endomysium (EMA),

tissue transglutaminase 2 (TG2) and deamidated

gliadin peptides (DGP)], HLA-DQ2 or HLA-

DQ8 haplotypes and enteropathy [1].

The accuracy of identifying and estimating

the real prevalence of CD has been improved in

recent years by the introduction of serological

screening tests: 0.6–1.0% of the European general

population is affected, with some regional differ-

ences (0.3% in Germany, 0.9% in Italy and 2.4%

in Finland) [2]. CD is also common in North and

South America, North Africa and the Middle

East. The prevalence of CD is increasing because

of a westernization of diets, changes in wheat

production and increased awareness of the dis-

ease.

CD offers a wide range of clinical presenta-

tions from severe gastrointestinal symptoms

(diarrhea, vomiting and failure to thrive) and

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 190–194
DOI: 10.1159/000367874

3.10 Celiac Disease

Riccardo Troncone  Marco Sarno