Elsevier

Clinical Nutrition

Volume 35, Issue 6, December 2016, Pages 1236-1241
Clinical Nutrition

Review
Gluten free diet and nutrient deficiencies: A review

https://doi.org/10.1016/j.clnu.2016.05.002Get rights and content

Summary

Background & aims

The only available treatment for celiac disease (CD) is lifelong adherence to gluten free (GF)-diet. However, GF-diet may lead to possible nutrient unbalance resulting in improper nutritional quality of diet. The aim of this study is to evaluate the nutritional quality of GF-diet.

Methods

MEDLINE®/PubMed and Cochrane Library were electronically searched for articles published between 1990/01/01 and 2015/09/01.

Results

GF-diet was found to be poor in alimentary fiber due in particular to the necessary avoidance of several kinds of foods naturally rich in fiber (i.e. grain) and the low content of fiber of GF product that are usually made with starches and/or refined flours. Micronutrients are also found to be poor, in particular Vit. D, Vit. B12 and folate, in addition to some minerals such as iron, zinc, magnesium and calcium. Moreover, an inadequate macronutrient intake was reported related above all to the focus on the avoidance of gluten that often leaving back the importance of nutritional quality of the choice. In particular, it was found a higher content of both saturated and hydrogenated fatty acids and an increase in the glycemic index and glycemic load of the meal.

Conclusions

Despite the GF-diet is necessary in celiac disease treatment and the attention is on gluten avoidance, the evaluation of nutritional quality of the diet must be considered. Moreover, educational strategies based on the relationship between nutrients and food and human health could be developed to optimize the therapeutic approach in celiac patients.

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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