Clinical Symptoms, Intestinal Histology and Nutrient Intake: The Celiac Study in Eastern Norway (CELIEN)

Abstract

Background and Aims: Little research has been conducted on the Norwegian celiac population. The clinical presentation of celiac disease (CD) is extensive, including both overt gastrointestinal complaints and vague atypical symptoms. Clinical symptoms and nutrient intake is an unexplored area, and may have great ramifications in terms of health and well-being. The impact of CD on celiac patients'; health and well being is of clinical importance to investigate. Considering that celiac patients receive financial support from the government, it is also of socioeconomic interest to gain more knowledge on this patient group. Hence, The Celiac Disease Study in Eastern Norway (CELIEN) was conducted. The main aim of this thesis was to investigate clinical symptoms and nutrient intake in the CELIEN study. Furthermore, clinical symptoms were explored in relation to intestinal histology, gluten-free diet (GFD) adherence and nutrient intake. Subjects and Methods: The current study recruited 58 celiac patients (mean age 44 years; range, 20-71 years; 76% women), diagnosed at least 10 years ago. Data on clinical symptoms and GFD adherence was collected from questionnaires. Daily intake of micronutrients was calculated using a four-day weighed food record. Duodenal biopsy specimen and blood samples were collected to provide information on intestinal histology and serum micronutrient values. Anthropometric assessments served as additional indicators of nutritional status. Results: The celiac patients in our sample reported only few and modest symptoms and health complaints. There was a significant difference in symptom score Role-Physical (SF-36), between the group with normal intestinal histology and the group with pathological features, with improved ability of working and accomplishing tasks in the group with normal histology. The adherent and non-adherent groups differed significantly on several symptom scales, with more symptoms reported in the non-adherent group. Furthermore, the results showed that the nutrient intake was not sufficiently covered regarding iron and dietary fibre in women, vitamin A and vitamin E in men and folate and vitamin D in both genders. The energy percentage from fat was above the recommended level in women. A more favourable intake of energy yielding nutrients was found in men. Higher percentage of energy from proteins and higher intake of calcium were associated with fewer symptoms. Conclusions: Our sample comprised celiac patients in general good health in terms of reporting clinical symptoms and health complaints to a small extent. The relationship between GFD adherence and symptoms emphasize the importance of keeping a strict GFD. The suboptimal intake of folate, vitamin D and dietary fibre, in particular, and the unfavourable fat distribution, highlights the importance of improving the GFD.