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      Concentraciones de Vitamina D en niños y adolescentes con enfermedad celíaca Translated title: Vitamin D concentrations in children and adolescents with celiac disease

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          Abstract

          Resumen: Introducción: En celíacos la ingesta de gluten provoca una lesión inflamatoria de origen autoinmune que causa un daño progresivo de las vellosidades del intestino delgado, comprometiendo la absorción de nutrientes y posible daño a otros órganos. Objetivo: Determinar las concentraciones plasmáticas de 25-hidroxivitamina D (25OHD) en niños y adolescentes chilenos con enfermedad celíaca. Pacientes y Método: Estudio descriptivo de corte transversal. Participaron 16 pacientes pediátricos de ambos sexos, diagnosticados con enfermedad celíaca. Se determinó antecedentes ge nerales, estado nutricional y parámetros bioquímicos. Las concentraciones plasmáticas de 25OHD se clasificaron como suficientes cuando estaban entre 30-100 ng/ml, insuficiente (20-29 ng/ml) y deficiente (< 20 ng/ml). Resultados: La edad de los pacientes estaba comprendida entre 5 y 18 edad (edad: 11 ± 4 años). De los participantes 4 de 16 presentaron concentraciones normales de 25OHD, 8 insuficiente y 1 deficiente. Según IMC, 11 tenían estado nutricional normal, 4 sobrepeso y 1 obesidad. El diagnóstico de la talla mostró 7 de 16 casos de talla baja y normal baja. Al relacionar las concentraciones de 25OHD con estado nutricional, los parámetros deficientes e insuficientes se concentraron en 9 pacientes con estado nutricional normal, 2 con sobrepeso y 1 con obesidad. Se realizaron asociaciones entre las concentraciones de 25OHD y todas las variables estudiadas y no se encontró ninguna asociación significativa. Conclusión: Se encontró una alta frecuencia de insuficiencia y deficiencia de 25OHD en el grupo de niños y adolescentes chilenos con enfermedad celíaca.

          Translated abstract

          Abstract: Introduction: In children with celiac disease, gluten intake causes an autoimmune, inflammatory and progressive lesion of the small intestine villi, compromising the absorption of nutrients and pos sible damage to others organs. Objective: To determine plasma 25-hydroxyvitamin D [25(OH)D] concentrations in Chilean child and adolescents with celiac disease. Patients and Method: A descrip tive cross-sectional study was carried out in which 16 pediatric patients of both genders diagnosed with celiac disease participated. General background, nutritional status and biochemical parameters were determined. Plasma 25(OH)D concentrations were classified as sufficient between 30-100 ng/ ml, insufficient between 20-30 ng/ml and deficient as <20 ng/ml. Results: The age of the patients was between 5 and 18 years (age: 11 ± 4 years). Four out of 16 participants had normal 25(OH)D concentrations, eight had insufficient concentrations and one had deficient concentrations. Accor ding to BMI, 11 patients had normal nutritional status, four were overweight and one was obese. In relation to height, seven out of 16 cases presented short stature and normal-low height. Associating 25(OH)D concentrations to nutritional status, nine patients with normal nutritional status, two with overweight and one with obesity presented deficient and insufficient parameters. No significant asso ciations were found between 25(OH)D concentrations and all studied variables. Conclusion: A high frequency of insufficiency and deficiency of 25(OH)D was found in the group of Chilean children and adolescents with celiac disease.

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          Most cited references21

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          Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

          Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.
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            Classification of body fatness by body mass index-for-age categories among children.

            To examine the ability of various body mass index (BMI)-for-age categories, including the Centers for Disease Control and Prevention's 85th to 94th percentiles, to correctly classify the body fatness of children and adolescents. Cross-sectional. The New York Obesity Research Center at St Luke's-Roosevelt Hospital from 1995 to 2000. Healthy 5- to 18-year-old children and adolescents (N = 1196) were recruited in the New York City area through newspaper notices, announcements at schools and activity centers, and word of mouth. Percent body fat as determined by dual-energy x-ray absorptiometry. Body fatness cutoffs were chosen so that the number of children in each category (normal, moderate, and elevated fatness) would equal the number of children in the corresponding BMI-for-age category ( or =95th percentile, respectively). About 77% of the children who had a BMI for age at or above the 95th percentile had an elevated body fatness, but levels of body fatness among children who had a BMI for age between the 85th and 94th percentiles (n = 200) were more variable; about one-half of these children had a moderate level of body fatness, but 30% had a normal body fatness and 20% had an elevated body fatness. The prevalence of normal levels of body fatness among these 200 children was highest among black children (50%) and among those within the 85th to 89th percentiles of BMI for age (40%). Body mass index is an appropriate screening test to identify children who should have further evaluation and follow-up, but it is not diagnostic of level of adiposity.
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              The clinical significance of 25OH-Vitamin D status in celiac disease.

              Reduced bone mineral density is frequently found especially in adult celiac disease (CD) and dietary guidelines favor vitamin D supplementation in adults and children with CD. Vitamin D serum levels were investigated in CD populations in order to challenge its routine supplementation. Israeli (61), Spanish (59), CD children (groups 1 and 5, respectively) were compared to children with nonspecific abdominal pain (56), their parents (84) and Spanish adult CD patients (22) (group 2, 3, 4, respectively). 25(OH)-vitamin D was checked by LIAISON chemiluminescent immunoassays. Groups 5 and 1 had the highest levels compared to groups 4 and 3 with the lowest levels. The levels in groups 1 and 2 were comparable. Concerning 25(OH)-vitamin D sera levels, only the difference between group 5 and 4 was statistically significant (30.3 ± 12.3 and 20.2 ± 10.5 ng/ml, respectively p=0.003). When vitamin D was splitted above and below 20 ng/ml level, 54.5% of Spanish adult CD had vitamin D deficiency compared to 16.9% of the local CD children (p=0.001). 29.6% of group 2 had deficient levels compared to their parents with 50% (p=0.019). In conclusion, Vitamin D sera levels negatively correlate with age. Thus, mainly adult CD population should be assessed for vitamin D levels and supplemented accordingly.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcp
                Revista chilena de pediatría
                Rev. chil. pediatr.
                Sociedad Chilena de Pediatría (Santiago, , Chile )
                0370-4106
                August 2018
                : 89
                : 4
                : 499-505
                Affiliations
                [3] Bío-Bío orgnameUniversidad de Concepción orgdiv1Facultad de Farmacia orgdiv2Departamento de Farmacia Chile
                [4] Bío-Bío orgnameUniversidad de Concepción orgdiv1Facultad de Ciencias Físicas y Matemáticas orgdiv2Departamento de Estadística Chile
                [2] Bío-Bío orgnameUniversidad de Concepción orgdiv1Facultad de Medicina orgdiv2Departamento de Pediatría Chile
                [1] Bío-Bío orgnameUniversidad de Concepción orgdiv1Facultad de Farmacia orgdiv2Departamento Nutrición y Dietética Chile
                Article
                S0370-41062018000400499
                12cddf94-7fe0-4083-8300-f2c921f14c89

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 14 May 2018
                : 30 August 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 7
                Product

                SciELO Chile


                Enfermedad celíaca,vitamina D,niños,adolescentes,estado nutricional,Celiac disease,vitamin D,children,adolescents,nutritional status

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