Effectiveness of nutritional supplementation for children with coeliac disease who are on a gluten-free diet

Patients on a gluten-free diet are at risk of developing polyhypoavitaminosis and deficiency states, which requires the supplementation of their diet to prevent nutrient deficiencies. The aim of the study: to analyze the dynamics of anthropometric and laboratory parameters, components of the quality of life in children with coeliac disease on the background of a month-long course of administration of hypercaloric mixture for enteric nutrition. Materials and methods: 45 children with coeliac disease aged 2-10 years (mean age 6.3 ± 0.3 years) on a strict gluten-free diet for more than one year. All patients received additional enteric nutrition with a hypercaloric mixture in the volume of 200 ml/day (300 kcal/day) for 1 month as a supplement to the main food ration. Two groups of patients receiving the supplement in 2012-2013 and 2017-2018 were identified. Physical development was assessed under the WHO AnthroPlus programme. The quality of life indicators were assessed using the PedQL 4.0 questionnaire. Results: the total frequency of protein-сalorie deficiency (PCD) before the course of nutritional supplementation was 13 (28.9%) cases, while acute PCD was diagnosed in 6 (13.3%) and chronic PCD in 7 (15.6%) patients. Against the background of the course of nutritious supplementation in children with coeliac disease, there was a significant reduction in weight, height and BMI in both groups. Patients in 2012-2013 initially had a greater gap in weight and height compared to children in 2017-2018. There was an improvement in the sum of the quality of life indicators by 6.3% for children in the first group and by 4.3% for children in the second group against the background of nutritional supplementation. Conclusions: Enrichment of children’s diets with a hypercaloric blend of dietary fiber helps to accelerate the pace of physical development, reduce the number of children with diabetes mellitus, improve hemogram rates and most components of quality of life.

1. Zakharova I.N., Borovik T.Eh., Korovina N.A., Roslavtseva E.A., Kasatkina E.N., Dmitrieva Yu.A. Coeliac disease in children: a modern view of the problem: a manual for doctors. Moscow: RMACPE; 2013. 90 p. (In Russ.)

2. Bel’mer S.V., Revnova M.O. (eds.). Coeliac disease in children. Moscow: Medpractice-M; 2015. 416 p. (In Russ.)

3. Skvortsova V.A., Netrebenko O.K., Borovik T.Eh. Eating disorders in young children. Lechashchiy vrach = Attending physician. 2011;(1):36–41. (In Russ.) Available at: https://www.lvrach.ru/2011/01/15435100/.

4. Lufta V.M., Bagnenko S.F. (ed.). Clinical Nutrition Guide. St. Petersburg: Artexpress; 2013. 448 p. (In Russ.)

5. Guevara Pacheco G., Chavez Cortes E., CastilloDuran C. Micronutrient deficiencies and celiac disease in Pediatrics. Arch Argent Pediatr. 2014;112(5):457–463. doi: 10.1590/S032500752014000500012.

6. Wierdsma N.J., van Bokhorst-de van der Schueren M.A., Berkenpas M., Mulder C.J., van Bodegraven A.A. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013;5(10):3975–3992. doi: 10.3390/nu5103975.

7. Belmer S.V. Current principles of dietary therapy for celiac disease. Rossijskij vestnik perinatologii i pediatrii = Russian Bulletin of perinatology and pediatrics. 2012;57(6):97–100. (In Russ.) Available at: https://elibrary.ru/item.asp?id=18271296.

8. Penagini F., Dilillo D., Meneghin F., Mameli C., Fabiano V., Zuccotti G.V. Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients. 2013;5(11):45534565. doi: 10.3390/nu5114553.

9. Kur’yaninova V.A. Clinical features and physical development of children with coeliac disease who are on a gluten-free diet: autoref. of Cand. of Sci. (Med) М., 2014. 24 p. (In Russ.)

10. Klimov L.Ya., Stoyan M.V., Kuryaninova V.A., Kashnicov V.S., Atanesyan R.A., Eremeeva O.I., et al. Anthropometric measures of children in the period of clinical manifestation of celiac disease. Eksperimental’naia i klinicheskaia gastroenterologiia = Experimental and clinical gastroenterology. 2013;(1):55–59. (In Russ.) Available at: https://elibrary.ru/item.asp?id=21161910.

11. Shepherd S.J., Gibson P.R. Nutritional inadequacies of the gluten-free diet in both recentlydiagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013;26(4):349–358. doi: 10.1111/jhn.12018.

12. Bascunan K.A., Vespa M.C., Araya M. Celiac disease: understanding the gluten-free diet. Eur J Nutr. 2017;56(2):449-459. doi: 10.1007/s00394016-1238-5.

13. Ohlund K., Olsson C., Hernell O., Ohlund I. Dietary shortcomings in children on a glutenfree diet. J Hum Nutr Diet. 2010;23(3):294-300. doi: 10.1111/j.1365-277X.2010.01060.x.

14. Bavykina I.A., Zvyagin A.A. Nutritional status of children on a long-term gluten-free diet. Voprosy prakticheskoy pediatrii = Clinical Practice in Pediatrics. 2013;1:55–59. (In Russ.) Available at: https://elibrary.ru/item.asp?id=23568776.

15. Klimov L.YA., Abramskaya L.M., Stoyan M.V., Kuryaninova V.A., Dolbnya S.V., Kasyanova A.N., Atanesyan R.A., Gerasimenko E.S., Yagupova A.V., Bobryshev D.V. Hormonal-metabolic patterns disorders of bone tissue mineralization in children with celiac disease. Meditsinskiy sovet = Medical Council. 2017;(1):149–154. (In Russ.) doi: 10.21518/2079-701X-2017-1-149-154

16. Blazina S., Bratanic N., Campa A.S., Blagus R., Orel R. Bone mineral density and importance of strict gluten-free diet in children and adolescents with celiac disease. Bone. 2010;47(3):598– 603. doi: 10.1016/j.bone.2010.06.008.

17. Klimov L.Ya., Stoyan M.V., Abramskaya L.M., Kuryaninova V.A., Kashnikov V.S., Kochneva L.D., Bobryshev D.V., Kasyanova A.N., Anisimov G.S. Lactase activity as a limiting factor in the use of dairy products in children with celiac disease. Prakticheskaya meditsina = Practical medicine. 2016;(8):67–71. (In Russ.) Available at: https://elibrary.ru/item.asp?id=27535896.

18. Akhmadullina O.V., Sabelnikova E.A., Belostovsky N.I., Parfenov A.I., Khomeriki S.G. Enzyme activity in the small intestine mucosa of celiac disease patients on gluten-free diet. Doctor.Ru. 2017;(2):22–25. (In Russ.) Available at: https://elibrary.ru/item.asp?id=29040487.

19. Klimov L.Ya., Stoyan M.V., Kuryaninova V.А., Kashnikov V.S., Eremeeva O.I., Zav’yalova Е.V., Gerasimenko E.S., Аbramskaya L.М., Kochneva L.D., Khomyakova N.S. The dynamics of the prevalence and a clinical-anthropometric characteristic of patients with coeliac disease in the Stavropol region: a retrospective analysis over a 20-year period. Vopr. det. dietol. = Pediatric Nutrition. 2018;16(3):5–14. (In Russ.) doi: 10.20953/1727-5784-2018-3-5-14.

20. Kansu A., Durmaz Ugurcan O., Arslan D., Unalp A., Celtik C., Sarioglu A.A. High‐fibre enteral feeding results in improved anthropometrics and favourable gastrointestinal tolerance in malnourished children with growth failure. Acta Paediatr. 2018;107(6):1036–1042. doi: 10.1111/apa.14240.

21. Gibson P.R., Muir J.G. Not all effects of a glutenfree diet are due to removal of gluten. Gastroenterology. 2013;145(3):693–693. doi: 10.1053/j.gastro.2013.06.056.

22. Kirby M., Danner E. Nutritional deficiencies in children on restricted diets. Pediatr Clin North Am. 2009;56(5):1085–1103. doi: 10.1016/j.pcl.2009.07.003.

23. Theethira T.G., Dennis M. Celiac disease and the gluten-free diet: consequences and recommendations for improvement. Dig Dis. 2015;33(2):175-182. doi: 10.1159/000369504.

24. Savvina A.D. Quality of life and ways to improve medical and social care for children with coeliac disease: autoref. of Cand. of Sci. (Med) Khabarovsk; 2009. 24 p. (In Russ.)

25. Samasca G., Sur G., Lupan I., Deleanu D. Glutenfree diet and quality of life in celiac disease. Gastroenterol Hepatol Bed Bench. 2014;7(3):139–143. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129563/.

26. Martinez-Martinez M.I., Alegre-Martinez A., Garcia-Ibanez J., Cauli O. Quality of life in people with coeliac disease: psychological and socio-economic aspects. Endocr Metab Immune Disord Drug Targets. 2019;19(2):116–120. doi: 10.2174/1871530318666180723100003.

27. Nikitina T.P., Kishtovich A.V., Moiseenko E.I., Sabirova A.V. Study of the quality of life in pediatrics: development of the Russian version of the PedsQL™ 4.0 Generic Core Scales questionnaire to assess the quality of life of children 8-12 years old. Vestnik Mezhnatsional’nogo tsentra issledovaniya kachestva zhizni = Multinational Center for Quality of Life Research. 2003;(1-2):35–44. (In Russ.) Available at: http://www.quality-life.ru/gyrnstat0103.php.

28. Vinyarskaya I.V., Chernikov V.V., Terletskaya R.N., Shcherbakova S.V., Fetisova А.N. Validation of the Russian Version of a Questionnaire for the Assessment of Utilitarian Indices in Pediatric Practice. Stage II. Voprosy sovremennoi pediatrii = Current Pediatrics. 2014;13(4):20–25. (In Russ.) Available at: https://elibrary.ru/item.asp?id=21991477.