Editorial
Impact of a gluten-free diet on patients with celiac disease, nonceliac gluten sensitivity, and asymptomatic controls
El impacto de la dieta libre de gluten en pacientes con enfermedad celiaca, sensibilidad al gluten no celiaca y controles asintomáticos
E. Coss-Adamea,b,
Corresponding author
enriquecossmd@gmail.com
Corresponding author at: Vasco de Quiroga 15, Col Sección XVI, Tlalpan, Mexico City, CP 14080, Mexico.
Corresponding author at: Vasco de Quiroga 15, Col Sección XVI, Tlalpan, Mexico City, CP 14080, Mexico.
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Remes-Troche, O. De J. Cobos-Quevedo, X. Rivera-Gutiérrez, G. Hernández, E. de la Cruz-Patiño, L.F. Uscanga-Domínquez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Remes-Troche" ] 1 => array:2 [ "nombre" => "O. De J." "apellidos" => "Cobos-Quevedo" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Rivera-Gutiérrez" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Hernández" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "de la Cruz-Patiño" ] 5 => array:2 [ "nombre" => "L.F." "apellidos" => "Uscanga-Domínquez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0375090619300242" "doi" => "10.1016/j.rgmx.2019.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0375090619300242?idApp=UINPBA000046" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255534X19300520?idApp=UINPBA000046" "url" => "/2255534X/0000008500000002/v1_202005070812/S2255534X19300520/v1_202005070812/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Impact of a gluten-free diet on patients with celiac disease, nonceliac gluten sensitivity, and asymptomatic controls" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "108" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Coss-Adame" "autores" => array:1 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Coss-Adame" "email" => array:1 [ 0 => "enriquecossmd@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Gastroenterología, Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, CDMX, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Curso de Motilidad Gastrointestinal, Universidad Nacional Autónoma de México (UNAM), Mexico City, CDMX, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Vasco de Quiroga 15, Col Sección XVI, Tlalpan, Mexico City, CP 14080, Mexico." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El impacto de la dieta libre de gluten en pacientes con enfermedad celiaca, sensibilidad al gluten no celiaca y controles asintomáticos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I attentively read the interesting article by Remes-Troche et al. that evaluated the effects of a 6-month gluten-free diet (GFD) on the metabolism of patients with celiac disease (CD), nonceliac gluten sensitivity, and on asymptomatic controls.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prospective study assessed the impact of a 6-month-long gluten-free diet on patients with CD (n = 22), nonceliac gluten sensitivity (n = 22), and asymptomatic controls (n = 22).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The diagnosis of nonceliac gluten sensitivity (NCGS) is known to be on the rise. Those patients do not present with significant villous atrophy, they have negative anti-endomysial and anti-tissue transglutaminase antibodies, and up to 50% present with some type of HLA haplotype linked to CD.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Population studies, the majority of which are based on self-reports of symptoms induced after the ingestion of gluten-containing compounds, have shown the prevalence of NCGS at 0.6 to 13%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Current scientific information is controversial, made more difficult by the fact there are no biomarkers available that would simplify NCGS diagnosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In addition, gluten is only one of the components of wheat, and the cause of NCGS symptomatology has been proposed to be another of those compounds (carbohydrates), and not necessarily gluten.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevertheless, gluten-free diets have become popular, and individuals that complain of symptoms after consuming gluten commonly go on a gluten-free diet.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The evidence from the article by Remes-Troche et al. indicates that a gluten-free diet induces changes in the metabolism of patients. It promoted the development of metabolic syndrome and obesity in 20% of the patients with CD, whereas in patients with NCGS, 5% developed obesity and nonalcoholic fatty liver increased by 20%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In an Italian study that evaluated metabolic changes in patients with CD, there was a 14.5% increase in metabolic syndrome, an 11% increase in hepatic steatosis, and an increase in body mass index, after beginning a gluten-free diet.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the same vein, Tortora et al. reported metabolic syndrome in 29.5% of patients with CD after beginning a gluten-free diet, in addition to an increase in waist circumference, blood pressure, and triglycerides.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Given those precedents, I emphasize the value of the article by Remes-Troche et al. for being the first to evaluate metabolic behavior in patients with NCGS and in healthy controls. It is very important to carry out a diagnostic approach in patients on a gluten-free diet, given that it is not an innocuous maneuver and can increase the risk for metabolic syndrome, overweight, obesity, and nonalcoholic fatty liver. It is important to discuss those possibilities with patients and guide them toward a diet that adequately meets their needs, with no need for aggressive restrictions.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial disclosure</span><p id="par0040" class="elsevierStylePara elsevierViewall">No financial support was received in relation to this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author declares that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial disclosure" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Coss-Adame E. El impacto de la dieta libre de gluten en pacientes con enfermedad celiaca, sensibilidad al gluten no celiaca y controles asintomáticos. Revista de Gastroenterología de México. 2020;85:107–108. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rgmx.2020.01.001">https://doi.org/10.1016/j.rgmx.2020.01.001</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic effects in patients with celiac disease, patients with nonceliac gluten sensitivity, and asymptomatic controls, after six months of a gluten-free diet" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Remes-Troche" 1 => "O.J. Cobos-Quevedo" 2 => "X. 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| 2024 April | 44 | 38 | 82 |
| 2024 March | 39 | 38 | 77 |
| 2024 February | 40 | 47 | 87 |
| 2024 January | 25 | 20 | 45 |
| 2023 December | 43 | 52 | 95 |
| 2023 November | 71 | 56 | 127 |
| 2023 October | 47 | 41 | 88 |
| 2023 September | 80 | 67 | 147 |
| 2023 August | 56 | 30 | 86 |
| 2023 July | 54 | 27 | 81 |
| 2023 June | 39 | 40 | 79 |
| 2023 May | 59 | 32 | 91 |
| 2023 April | 31 | 24 | 55 |
| 2023 March | 63 | 43 | 106 |
| 2023 February | 37 | 23 | 60 |
| 2023 January | 29 | 28 | 57 |
| 2022 December | 73 | 33 | 106 |
| 2022 November | 62 | 52 | 114 |
| 2022 October | 59 | 41 | 100 |
| 2022 September | 39 | 37 | 76 |
| 2022 August | 39 | 25 | 64 |
| 2022 July | 41 | 37 | 78 |
| 2022 June | 35 | 42 | 77 |
| 2022 May | 40 | 32 | 72 |
| 2022 April | 54 | 62 | 116 |
| 2022 March | 52 | 81 | 133 |
| 2022 February | 60 | 53 | 113 |
| 2022 January | 42 | 49 | 91 |
| 2021 December | 39 | 55 | 94 |
| 2021 November | 38 | 62 | 100 |
| 2021 October | 97 | 102 | 199 |
| 2021 September | 63 | 58 | 121 |
| 2021 August | 60 | 75 | 135 |
| 2021 July | 53 | 49 | 102 |
| 2021 June | 43 | 73 | 116 |
| 2021 May | 39 | 77 | 116 |
| 2021 April | 103 | 147 | 250 |
| 2021 March | 45 | 58 | 103 |
| 2021 February | 30 | 30 | 60 |
| 2021 January | 34 | 32 | 66 |
| 2020 December | 20 | 22 | 42 |
| 2020 November | 35 | 31 | 66 |
| 2020 October | 28 | 29 | 57 |
| 2020 September | 77 | 38 | 115 |
| 2020 August | 111 | 49 | 160 |
| 2020 July | 62 | 44 | 106 |
| 2020 June | 35 | 31 | 66 |
| 2020 May | 61 | 41 | 102 |
| 2020 April | 27 | 25 | 52 |
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