ÇÖLYAK HASTALIĞINDA MİKRO BESİN ÖGESİ EKSİKLİKLERİ VE BESLENME ÖNERİLERİ

Yıl 2021, Cilt: 3 Sayı: 1, 29 - 38, 30.04.2021

Esra Tunçer , Nurcan Yabancı Ayhan

https://doi.org/10.46413/boneyusbad.807225

Cited By: 1

Öz

Çölyak; genetik yatkınlığı olan bireylerde glutenin tüketilmesiyle tetiklenen, ince bağırsaklarda inflamasyona neden olan sistemik, immün aracılı bir hastalıktır ve tedavisi glutensiz diyettir. Malabsorbsiyonlar ve glutensiz diyetin bazı besin ögelerini (magnezyum, tiamin, riboflavin, niasin vb.) yeterli miktarda içermemesi nedenleriyle çölyak hastalığında besin ögesi eksiklikleri görülebilir. Bu derlemenin amacı, çölyak hastalığında mikro besin ögesi eksiklerini literatür kapsamında incelemektir.
Çölyak tanısı sırasında sık görülen mikro besin ögesi eksikleri demir, kalsiyum, magnezyum, D vitamini, çinko, folat, niasin, B12 vitamini, riboflavin şeklinde sayılmaktadır.
Sonuçta, çölyak hastalığında vitamin-mineral eksikliklerinin tedavisi için glutensiz diyete uyum ile optimal beslenmenin sağlanmasının gerekliliği görülmektedir. Ayrıca, gereken durumlarda hekim kontrolünde besin takviyesi alınmalıdır.

Anahtar Kelimeler

Çölyak hastalığı, Beslenme bilimi, Mineraller, Vitaminler

Destekleyen Kurum

Yoktur.

Proje Numarası

Yoktur.

MICRONUTRIENTS DEFICIENCIES AND NUTRITIONAL RECOMMENDATIONS IN CELIAC DISEASE

Öz

Celiac disease, which is triggered by consuming gluten in individuals with a genetic predisposition, is a systemic, immune-mediated disease, causing inflammation in the small intestine, and its treatment is the gluten-free diet. Nutritional deficiencies can be observed in celiac disease due to malabsorption, and a gluten-free diet may not contain enough nutrients (magnesium, thiamine, riboflavin, niacin, etc.). This review aims to evaluate micronutrient deficiencies in celiac disease in the context of the literature.
Micronutrient deficiencies frequently seen during the diagnosis of celiac are stated as iron, calcium, magnesium, vitamin D, zinc, folate, niacin, vitamin B12, riboflavin deficiencies.
In conclusion, it is necessary to adherence to a gluten-free diet and to ensure optimal nutrition for the treatment of vitamin-mineral deficiencies in celiac disease. In addition, when necessary, nutritional supplements should be taken under the control of a physician.

Anahtar Kelimeler

Celiac disease, Nutritional science, Minerals, Vitamins

Proje Numarası

Yoktur.

Kaynakça

• Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C., ... Lundin, K. E. A. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterology Journal, 7 (5), 583-613. doi:10.1177/2050640619844125
• Babio, N., Alcazar, M., Castillejo, G., Recasens, M., Martinez-Cerezo, F., Gutierrez-Pensado, V., ... Salas-Salvado, J. (2017). Patients With Celiac Disease Reported Higher Consumption of Added Sugar and Total Fat Than Healthy Individuals. Journal of Pediatric Gastroenterology and Nutrition, 64 (1), 63-69. doi:10.1097/MPG.0000000000001251
• Bai, J. C., Ciacci, C. (2017). World Gastroenterology Organisation Global Guidelines: Celiac Disease February 2017. Journal of Clinical Gastroenterology, 51 (9), 755-768. doi:10.1097/MCG.0000000000000919
• Balamtekin, N., Aksoy, C., Baysoy, G., Uslu, N., Demir, H., Koksal, G., ... Yuce, A. (2015). Is compliance with gluten-free diet sufficient? Diet composition of celiac patients. The Turkish Journal of Pediatrics, 57 (4), 374-379
• Beker Şanlı, D., Aliyazıcıoğlu, Y., Kalaycı, A. G. (2015). Pediatrik çölyak hastalarında homosistein, vitamin B12 ve folik asit düzeyleri. Güncel Pediatri, 13, 1-6. doi: 10.4274/jcp.92400
• Caruso, R., Pallone, F., Stasi, E., Romeo, S., Monteleone, G. (2013). Appropriate nutrient supplementation in celiac disease. Annals of Medicine, 45 (8), 522-531. doi:10.3109/07853890.2013.849383
• Choudhary, G., Gupta, R. K., Beniwal, J. (2017). Bone Mineral Density in Celiac Disease. Indian Journal of Pediatrics, 84 (5), 344-348. doi:10.1007/s12098-016-2273-1
• Choung, R. S., Unalp-Arida, A., Ruhl, C. E., Brantner, T. L., Everhart, J. E., Murray, J. A. (2016). Less Hidden Celiac Disease But Increased Gluten Avoidance Without a Diagnosis in the United States: Findings From the National Health and Nutrition Examination Surveys From 2009 to 2014. Mayo Clinic Proceedings, S0025-6196(16)30634-6. doi:10.1016/j.mayocp.2016.10.012
• Comba, A., Demirbaş, F., Eren, E., Çaltepe, G., Kayadi̇bi̇, H., Kalaycı, A. G. (2018). Çölyak hastalarında serum homosistein düzeylerinin değerlendirilmesi. Pamukkale Tıp Dergisi, 11 (3), 215-222. doi:10.31362/patd.402656 Demirçeken, F. G. (2011). Gluten enteropatisi (Çölyak hastalığı): klasik bir öykü ve güncel gelişmeler. Güncel Gastroenteroloji, 15, 58-72.
• Di Nardo, G., Villa, M. P., Conti, L., Ranucci, G., Pacchiarotti, C., Principessa, L., ... Parisi, P. (2019). Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review. Nutrients, 11 (7). doi:10.3390/nu11071588
• EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies). (2014a). Scientific opinion on dietary reference values for zinc. EFSA Journal, 12 (10), 3844, 76 pp. doi:10.2903/j.efsa.2014.3844
• EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies). (2014b). Scientific opinion on dietary reference values for folate. EFSA Journal, 12 (11), 3893, 59 pp. doi:10.2903/j.efsa.2014.3893
• EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies). (2015). Scientific opinion on dietary reference values for iron. EFSA Journal, 13 (10), 4254, 115 pp. doi:10.2903/j.efsa.2015.4254
• Faerber, E. (2011). Selenium supplement information for your gluten-free patients. Erişim tarihi 06.10.2020, http://depts.washington.edu/nutr/wordpress/wp-content/uploads/2015/03/Selenium_2012.pdf
• Fathi, F., Ektefa, F., Tafazzoli, M., Rostami, K., Rostami Nejad, M., Fathi, M., … Zali, M. R. (2013). The concentration of serum zinc in celiac patients compared to healthy subjects in Tehran. Gastroenterology and Hepatology from Bed to Bench, 6 (2), 92-95.
• Fernandez, C. B., Varela-Moreiras, G., Ubeda, N., Alonso-Aperte, E. (2019). Nutritional Status in Spanish Children and Adolescents with Celiac Disease on a Gluten Free Diet Compared to Non-Celiac Disease Controls. Nutrients, 11 (10). 2329. doi: 10.3390/nu11102329.
• Foschia, M., Horstmann, S., Arendt, E. K., Zannini, E. (2016). Nutritional therapy - Facing the gap between coeliac disease and gluten-free food. International Journal of Food Microbiology, 239, 113-124. doi:10.1016/j.ijfoodmicro.2016.06.014
• Freeman, H. J. (2015). Iron deficiency anemia in celiac disease. World Journal of Gastroenterology, 21 (31), 9233-9238. doi:10.3748/wjg.v21.i31.9233
• Garcia-Manzanares, A., Lucendo, A. J. (2011). Nutritional and dietary aspects of celiac disease. Nutrition in Clinical Practice, 26 (2), 163-173. doi:10.1177/0884533611399773
• Green, P. H., Lebwohl, B., Greywoode, R. (2015). Celiac disease. The Journal of Allergy and Clinical Immunology, 135 (5), 1099-1106. doi:10.1016/j.jaci.2015.01.044
• Hancock, R., Koren, G. (2004). Celiac disease during pregnancy. Canadian Family Physician Médecin De Famille Canadien, 50, 1361-1363.
• Kavak, U. S., Yuce, A., Kocak, N., Demir, H., Saltik, I. N., Gurakan, F., Ozen, H. (2003). Bone mineral density in children with untreated and treated celiac disease. Journal of Pediatric Gastroenterology and Nutrition, 37 (4), 434-436. doi:10.1097/00005176-200310000-00007
• Kreutz, J. M., Adriaanse, M. P. M., van der Ploeg, E. M. C., Vreugdenhil, A. C. E. (2020). Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease. Nutrients, 12 (2). doi:10.3390/nu12020500
• Leivers, C., Martin, G., Gasparetto, M., Shelley, H., Valente, M. (2014). Coeliac disease. Paediatrics and Child Health, 24 (11), 481-484. doi:10.1016/j.paed.2014.05.004
• Mager, D. R., Qiao, J., Turner, J. (2012). Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease. European Journal of Clinical Nutrition, 66 (4), 488-495. doi:10.1038/ejcn.2011.176
• Marti-Carvajal, A. J., Sola, I., Lathyris, D., Dayer, M. (2017). Homocysteine-lowering interventions for preventing cardiovascular events. The Cochrane Database of Systematic Reviews, 8 (8), CD006612. doi:10.1002/14651858.CD006612.pub5
• Martin, J., Geisel, T., Maresch, C., Krieger, K., Stein, J. (2013). Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion, 87 (4), 240-246. doi:10.1159/000348850
• Martin-Masot, R., Nestares, M. T., Diaz-Castro, J., Lopez-Aliaga, I., Alferez, M. J. M., Moreno-Fernandez, J., Maldonado, J. (2019). Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients, 11 (11), 2557. doi:10.3390/nu11112557
• Nestares, T., Martin-Masot, R., Labella, A., Aparicio, V. A., Flor-Alemany, M., Lopez-Frias, M., Maldonado, J. (2020). Is a Gluten-Free Diet Enough to Maintain Correct Micronutrients Status in Young Patients with Celiac Disease? Nutrients, 12 (3), 844. doi:10.3390/nu12030844
• Niewinski, M. M. (2008). Advances in celiac disease and gluten-free diet. Journal of The American Dietetic Association, 108 (4), 661-672. doi:10.1016/j.jada.2008.01.011
• Niro, S., D'Agostino, A., Fratianni, A., Cinquanta, L., Panfili, G. (2019). Gluten-Free Alternative Grains: Nutritional Evaluation and Bioactive Compounds. Foods, 8 (6), 208. doi:10.3390/foods8060208
• Özkaya, V., Özkaya, Ş. Ö. (2018). Çölyak hastalığına diyetetik yaklaşım. Selçuk Tıp Dergisi, 34 (4), 186-193. doi: 10.30733/std.2018.00906
• Pagano, A. E. (2007). The Gluten-Free Vegetarian. Practical Gastroenterology, 31 (5), 94-106.
• Penagini, F., Dilillo, D., Meneghin, F., Mameli, C., Fabiano, V., Zuccotti, G. V. (2013). Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients, 5 (11), 4553-4565. doi:10.3390/nu5114553
• Popov, J., Baldawi, M., Mbuagbaw, L., Gould, M., Mileski, H., Brill, H., Pai, N. (2018). Iron Status in Pediatric Celiac Disease: A Retrospective Chart Review. Journal of Pediatric Gastroenterology and Nutrition, 66 (4), 651-653. doi:10.1097/MPG.0000000000001761
• Presutti, R. J., Cangemi, J. R., Cassidy, H. D., Hill, D. A. (2007). Celiac disease. American Family Physician, 76 (12), 1795-1802.
• Reilly, N. R. (2016). The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad. The Journal of Pediatrics, 175, 206-210. doi:10.1016/j.jpeds.2016.04.014
• Rondanelli, M., Faliva, M. A., Gasparri, C., Peroni, G., Naso, M., Picciotto, G., ... Perna, S. (2019). Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review. Medicina (Kaunas), 55 (7), 337. doi:10.3390/medicina55070337
• Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., Murray, J. A. (2013). ACG clinical guidelines: diagnosis and management of celiac disease. The American Journal of Gastroenterology, 108 (5), 656-676. doi:10.1038/ajg.2013.79
• Rujner, J., Socha, J., Syczewska, M., Wojtasik, A., Kunachowicz, H., Stolarczyk, A. (2004). Magnesium status in children and adolescents with coeliac disease without malabsorption symptoms. Clinical Nutrition, 23 (5), 1074-1079. doi:10.1016/j.clnu.2003.10.018
• Saturni, L., Ferretti, G., Bacchetti, T. (2010). The gluten-free diet: safety and nutritional quality. Nutrients, 2 (1), 16-34. doi:10.3390/nu2010016
• See, J., Murray, J. A. (2006). Gluten-free diet: the medical and nutrition management of celiac disease. Nutrition in Clinical Practice, 21 (1), 1-15. doi:10.1177/011542650602100101
• Serin, Y., Akbulut, G. (2017). Çölyak hastalığı ve glutensiz diyet tedavisine güncel yaklaşım. Türkiye Klinikleri Journal of Health Sciences, 2 (3), 192-200. doi: 10.5336/healthsci.2016-53640
• Simpson, S., Thompson, T. (2012). Nutrition assessment in celiac disease. Gastrointestinal Endoscopy Clinics of North America, 22 (4), 797-809. doi:10.1016/j.giec.2012.07.010
• Singh, P., Arora, A., Strand, T. A., Leffler, D. A., Catassi, C., Green, P. H., … Makharia, G. K. (2018). Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology, 16 (6), 823-836.e2. doi:10.1016/j.cgh.2017.06.037
• Theethira, T. G., Dennis, M. (2015). Celiac disease and the gluten-free diet: consequences and recommendations for improvement. Digestive Diseases, 33 (2), 175-182. doi:10.1159/000369504
• Thompson, T. (1999). Thiamin, riboflavin, and niacin contents of the gluten-free diet: is there cause for concern? Journal of the American Dietetic Association, 99 (7), 858-862. doi:10.1016/S0002-8223(99)00205-9
• Thompson, T., Dennis, M., Higgins, L. A., Lee, A. R., Sharrett, M. K. (2005). Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? Journal of Human Nutrition and Dietetics, 18 (3), 163-169. doi:10.1111/j.1365-277X.2005.00607.x
• Türkiye Cumhuriyeti Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. (2017). Çölyak ve Görülme Sıklığı. Erişim tarihi 06.10.2020, https://hsgm.saglik.gov.tr/tr/metabolizma-ve-colyak/%C3%A7%C3%B6lyak-ve-g%C3%B6r%C3%BClme-s%C4%B1kl%C4%B1%C4%9F%C4%B1.html
• Türkiye Cumhuriyeti Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Sağlıklı Beslenme ve Hareketli Hayat Daire Başkanlığı. (2019). Çölyak Hastalığında Aile Hekimleri İçin Tanı, Tedavi ve İzlem Rehberi, Sağlık Bakanlığı Yayın No: 1111, Ankara.
• Ünal, F., Umman, C., Cebe Tok, A., Semizel, E., Ecevit, Ç. Ö., Özdemir, S., ... Kasırga, E. (2012). Glutensiz diyet alan çölyak hastası çocuklarda serum selenyum düzeyleri. Güncel Pediatri, 10 (2), 55-58.
• Valente, F. X., Campos, T., N., Moraes, L. F. S., Hermsdorff, H. H. M., Cardoso, L., M., Pinheiro-Sant'Ana, H. M., ... Peluzio, M. C. G. (2015). B vitamins related to homocysteine metabolism in adults celiac disease patients: a cross-sectional study. Nutrition Journal, 14, 110. doi:10.1186/s12937-015-0099-8
• Vici, G., Belli, L., Biondi, M., Polzonetti, V. (2016). Gluten free diet and nutrient deficiencies: A review. Clinical Nutrition, 35 (6), 1236-1241. doi:10.1016/j.clnu.2016.05.002
• Zanchetta, M. B., Longobardi, V., Bai, J. C. (2016). Bone and Celiac Disease. Current Osteoporosis Reports, 14 (2), 43-48. doi:10.1007/s11914-016-0304-5
• Zylberberg, H. M., Lebwohl, B., RoyChoudhury, A., Walker, M. D., Green, P. H. R. (2018). Predictors of improvement in bone mineral density after celiac disease diagnosis. Endocrine, 59 (2), 311-318. doi:10.1007/s12020-017-1488-x