Original Contribution

The American Journal of Gastroenterology (2006) 101, 2356–2359; doi:10.1111/j.1572-0241.2006.00750.x

Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet

William Dickey MD, PhD, FACG and Natalie Kearney BSc

Departments of Gastroenterology and Dietetics, Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom

Correspondence: Dr W Dickey, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, UK.

Received 12 January 2006; Accepted 27 April 2006.

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Abstract

BACKGROUND:

 

It is well established that a minority of celiac patients present with "classic" symptoms due to malabsorption. However, few studies have focussed on the distribution of body mass index (BMI) in celiac populations and its relationship to clinical characteristics, or on its response to treatment.

METHODS:

 

We reviewed BMI measurements and other clinical and pathological characteristics from a database of 371 celiac patients diagnosed over a 10-yr period and seen by a single gastroenterologist. To assess response to gluten exclusion, we compared BMI at diagnosis and after 2 yr treatment in patients with serological support for dietary compliance.

RESULTS:

 

Mean BMI was 24.6 kg/m2 (range 16.3–43.5). Seventeen patients (5%) were underweight (BMI <18.5), 211 (57%) were normal, and 143 (39%) were overweight (BMI greater than or equal to25), including 48 (13% of all patients) in the obese range (BMI greater than or equal to30.0). There was a significant association between low BMI and female gender, history of diarrhea, reduced hemoglobin concentration, reduced bone mineral density (BMD), osteoporosis, and higher grades (subtotal/total) of villous atrophy. Of patients compliant with a gluten-free diet, 81% had gained weight after 2 yr, including 82% of initially overweight patients.

CONCLUSIONS:

 

Few celiac patients are underweight at diagnosis and a large minority is overweight; these are less likely to present with classical features of diarrhea and reduced hemoglobin. Failed or delayed diagnosis of celiac disease may reflect lack of awareness of this large subgroup. The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.