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The Effect of Gluten-free Diet on Cardiovascular Risk Factors in Newly Diagnosed Pediatric Celiac Disease Patients

Zifman, Eyal*,†; Waisbourd-Zinman, Orith*,‡; Marderfeld, Luba*,§; Zevit, Noam*,‡; Guz-Mark, Anat*,‡; Silbermintz, Ari*; Assa, Amit*,‡; Mozer-Glassberg, Yael*; Biran, Neta*,§; Reznik, Dana*,§; Poraz, Irit*,§; Shamir, Raanan*,‡

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 684–688
doi: 10.1097/MPG.0000000000002235
Original Article: Gastroenterology: Celiac Disease

Objectives: Although gluten-free diet (GFD) is the only proven therapy for celiac disease (CD), its effect on cardiovascular disease (CVD) risk factors is still unclear. Our aim was to determine whether adherence to GFD affects CVD risk factors among newly diagnosed pediatric CD subjects.

Methods: We prospectively enrolled pediatric subjects undergoing upper gastrointestinal endoscopy for suspected CD. We collected anthropometric and laboratory parameters related to CVD risk factors at the time of CD diagnosis and 1 year after initiation of a GFD and evaluated changes in CVD risk factors. Paired t tests or Wilcoxon nonparametric tests were used, each when appropriate.

Results: One hundred ten newly diagnosed CD pediatric subjects were included in the analysis. There were 64 (58.2%) girls and the mean age at diagnosis was 6.8 ± 3.4 years. Median body mass index z scores (P = 0.84), rates of underweight or overweight (P = 0.32), and rates of elevated blood pressure (P = 0.78) remained unchanged. Although median fasting insulin levels increased (1.9 vs 5.4 μU/mL, P < 0.001), insulin resistance as measured by homeostatic model assessment did not increase after 1 year of GFD (P = 0.16). Although rates of dyslipidemia remained unchanged, median high-density lipoprotein levels increased on GFD (47 vs 51 mg/dL, P < 0.001).

Conclusions: In this pediatric CD cohort, GFD for 1 year was not associated with increased CVD risk factors. The long-term significance of these mild changes is yet to be determined.

*Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva

Pediatric Gastroenterology Clinic, Pediatric Division, Meir Medical Center, Kfar-Saba

§Clinical Nutrition and Dietetics Department, Schneider Children's Medical Center of Israel, Petach-Tikva

Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Address correspondence and reprint requests to Eyal Zifman, MD, Pediatric Gastroenterology Clinic, Meir Medical Center, 59th Tchernichovsky St, Kfar Saba 4464402, Israel (e-mail:

Received 5 September, 2018

Accepted 26 October, 2018

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,