ReviewGluten free diet and nutrient deficiencies: A review
Introduction
Celiac disease (CD) is a chronic enteropathy which affects approximately 1% of the general population [1]. Now, the only treatment is strict lifelong adherence to a gluten-free diet (GF-diet) which leads to disappearance of the signs/symptoms [1], [2]. Removing completely gluten from the diet of celiac patients will result, in the majority of patients, in remission in terms of symptoms and serologic and histological aspects [3]. It is reported that many disease complication can be avoided with gluten removal and in children growth and development can return to normal with the adherence to the GF-diet [3], [4].
However, it is not always simple for CD patient to strictly follow a GF-diet and to make the right nutritional choices [5].
Moreover, GF-diet may lead to possible nutrient deficiencies (such as fiber and specific micronutrients) or nutrient excess (i.e. saturated fats). Gluten-free products are usually lower in fiber, magnesium and folic acid and gluten-free cereals found in nature have a lower magnesium content compared with gluten-containing ones [6], [7], [8].
The aim of this study is to determine and evaluate the nutritional quality of GF-diet and the impact on specific nutrients such as iron, folate, fiber, vitamins (in particular Vit. B12 and Vit. D), zinc, magnesium and calcium.
Section snippets
Literature search
MEDLINE®/PubMed and Cochrane were electronically searched for articles published between 1990/01/01 and 2015/09/01. A combination of keywords addressing “gluten”, “gluten-free diet”, “gluten free”, “gluten free diet” OR “nutritional” OR “quality” were used.
Inclusion criteria
Observation study, controlled clinical trial (CCT), meta-analysis, systematic review, and consensus conferences were included as random controlled trials (RCTs) with randomization at any level. Studies regarding gluten sensitivity were
Results
As reported in Table 1, several studies reveal different nutrients inadequacies in GF-diet.
Conclusion
Analyzing the nutritional value of the GF-diet, it is common to identify remarkable inadequacies in terms of both macro- and micronutrients (Fig. 2).
In particular, it is observed a decrease in vitamins and minerals with an increase of obesity risk due to the high glycemic index of the gluten-free diet and the high content of saturated lipids.
Nutrient deficiencies, particularly low levels of fibers, folate, vitamin B12, vitamin D, calcium, iron, zinc and magnesium can persist in some subsets of
Conflict of interest
None.
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