Newly Diagnosed Celiac Disease Patients are Usually Overweight or Obese and Not Underweight

Celiac.com 10/14/2024 - Celiac disease has long been associated with symptoms like malnutrition and weight loss due to malabsorption issues caused by damage to the small intestine. However, recent studies suggest that the presentation of celiac disease may be changing. This systematic review and meta-analysis aimed to investigate the prevalence of obesity, overweight, and underweight in patients newly diagnosed with celiac disease. The study reviewed data from several research sources to provide a comprehensive overview of body mass index trends among those diagnosed with celiac disease before they started a gluten-free diet.

Methodology and Data Sources

The research team conducted an extensive search across multiple databases, including PubMed, Embase, Scopus, and Web of Science, to identify studies that focused on the body mass index of newly diagnosed celiac disease patients. These studies measured the prevalence of underweight, overweight, and obesity at the time of diagnosis. Only studies that utilized accepted body mass index categories, which classify a body mass index above 30 as obesity, above 25 as overweight, and below 18.5 as underweight, were included in the analysis. In total, 23 studies involving more than 15,000 celiac patients were analyzed alongside a comparison group of over 800,000 healthy individuals.

Key Findings

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The meta-analysis revealed surprising findings that challenge the conventional view of celiac disease as a condition primarily associated with being underweight. Only 11% of newly diagnosed celiac patients were found to be underweight. On the other hand, approximately 37% of the patients were overweight or obese at the time of diagnosis. This marked an increase in the prevalence of obesity and overweight in celiac patients over the years. Between 2003 and 2009, around 22% of patients were either overweight or obese, but this figure rose to 32% in studies conducted from 2016 to 2021.

The analysis also found that patients with a higher body mass index tended to be older and, to a lesser degree, female. These patients were less likely to present with typical gastrointestinal symptoms of celiac disease, which could contribute to delays in diagnosis. Moreover, the prevalence of underweight among celiac patients decreased, aligning more closely with the rates of underweight seen in the general population.

Trends Over Time and Geographical Differences

The study revealed significant changes in the body mass index trends of celiac disease patients over time. In the early 2000s, it was more common to see celiac patients who were underweight, but by the mid-2010s, the proportion of overweight and obese patients had increased significantly. This shift could be attributed to various factors, including greater awareness of celiac disease, more widespread screening efforts, and better access to gluten-free foods that are often high in calories and fat.

Geographically, the prevalence of obesity and overweight among celiac patients varied. In North American and European studies, overweight and obesity rates were significantly higher than in studies conducted in countries like India, where a larger proportion of celiac patients were still underweight at the time of diagnosis. These differences may reflect varying levels of access to healthcare and differences in diet and lifestyle between countries.

Implications for Celiac Disease Diagnosis

The findings of this study highlight the importance of not relying solely on weight status when diagnosing celiac disease. The traditional view that celiac patients are typically underweight has been challenged by the significant proportion of newly diagnosed patients who are overweight or obese. This shift suggests that many overweight or obese individuals with celiac disease may go undiagnosed for longer periods because their weight does not fit the stereotypical presentation of the disease. As a result, they may suffer from the long-term effects of untreated celiac disease, including nutrient malabsorption, autoimmune disorders, and increased risk of certain cancers.

Physicians and healthcare providers should be aware that weight alone is not a reliable indicator of celiac disease. Overweight or obese individuals who present with other symptoms, such as fatigue, bloating, or unexplained nutrient deficiencies, should still be evaluated for celiac disease, even if they do not fit the traditional clinical profile.

The Role of a Gluten-Free Diet

One of the most interesting findings of this study is the role that a gluten-free diet can play in the weight status of celiac patients. Many studies have shown that after starting a gluten-free diet, patients often gain weight. This is due to the restoration of intestinal function and the ability to absorb nutrients more effectively. However, there is also evidence that patients on a gluten-free diet tend to consume more processed, calorie-dense gluten-free products, which may contribute to weight gain over time.

A Growing Number of Newly Diagnosed Celiac Patients are Overweight or Obese

This systematic review and meta-analysis provide important insights into the changing presentation of celiac disease. While the disease was once primarily associated with being underweight, a growing number of newly diagnosed patients are now overweight or obese. This has significant implications for the way celiac disease is diagnosed and managed. It is crucial for both doctors and patients to recognize that celiac disease can occur at any weight and that relying on weight status alone may lead to delays in diagnosis and treatment.

For individuals with celiac disease, this study reinforces the need for careful dietary management and long-term monitoring. Following a gluten-free diet can lead to significant health improvements, but it is also important to make healthy food choices to avoid unintended weight gain or other complications. This research underscores the importance of a holistic approach to managing celiac disease, one that considers the full spectrum of symptoms and health outcomes beyond just weight.

Read more at: bmcgastroenterol.biomedcentral.com