A novel gluten-free meal as a nutritional therapy for Iron deficiency anemia in children with celiac disease

Celiac disease (CD) is a genetically determined autoimmune disease characterized by a long lasting intolerance to gluten. The gluten-free diet (GFD) is currently the only treatment for celiac disease; however, unbalanced selection of gluten-free products may lead to nutritional deficiencies. We aim in this study to explore the extent of iron deficiency anemia in children with celiac disease, and to assess the efficacy of introduction of a newly designed healthy, balanced, gluten-free meal on their clinical and biochemical parameters. A prospective study enrolling 50 children with CD diagnosed at out-patient clinic of pediatric gastroenterology, specialized pediatric hospital, Cairo University; by duodenal biopsy and serology, they were on gluten-free diet for at least one year. 40 healthy subjects were taken as a control group. Full History taking including symptoms of celiac disease and dietary history, anthropometric assessment and full clinical examination were performed for all the study population. We gave our balanced gluten-free meal to CD patients twice per day, for 3 successive months. Venous blood samples were withdrawn from patients once before the meal and another time after 3 months for assessment of hemoglobin concentration (Hb), serum iron, and ferritin and lipid profile. The mean values of anthropometric measurements, Hb level and iron indices were significantly lower in CD patients compared to controls. There was marked improvement in anthropometric measurements, increasing Hb (from 10.3 +/- 1.2 to 11.7 +/- 1.1) (P=0.02), MCV (from 68.2 +/- 6.5 to 76.5 +/- 3.7) (P=0.02), ferritin (from 45.7 +/- 10.6 to 90.4 +/- 16.1) (P=0.01), serum iron (from 68.7 +/- 10.4 to 83.4 +/- 15.2) (P<0.001), HDL (from 64.5 +/- 15.1 to 81.6 +/- 19.3) (P=0.02), while there was a significant reduction of serum cholesterol (from 153.7 +/- 38.2 to 119.5 +/- 29.8) (P<0.001), triglyceride (from 111.7 +/- 25.3 to 85.4 +/- 21.1) (P=0.005) after 3 months of ingestion of the designed meal. The designed meal proved to be of high nutritional value in management of iron deficiency anemia in CD patient