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Introdução: A Doença Celíaca (DC) é uma doença inflamatória crónica e autoimune, caracterizada pela intolerância permanente ao glúten em indivíduos geneticamente suscetíveis. A etiologia da DC é multifatorial, com uma forte interação entre fatores genéticos, nomeadamente o Antigénio Leucocitário Humano da Classe 2 (HLA-DQ2), imunológicos e ambientais. O diagnóstico da DC baseia-se na avaliação clínica laboratorial (marcadores serológicos) e na realização de uma biópsia (marcadores histológicos). Atualmente o tratamento para a DC baseia-se numa Dieta Isenta de Glúten (DIG) durante toda a vida. A ingestão de alimentos com glúten provoca uma inflamação da mucosa intestinal nomeadamente atrofia das vilosidades intestinais, com consequente diminuição da superfície de absorção e de enzimas necessárias à absorção, e hiperplasia compensatória das criptas de Lieberkϋhn. Com a absorção diminuída, várias carências nutricionais podem ocorrer, entre elas, a deficiência de vitaminas D, E, B12, ferro, cálcio e zinco. Apesar da simplicidade de transformar uma dieta com glúten numa DIG, o desenvolvimento de produtos sem glúten pela indústria tem sido questionado no que respeita à adequação nutricional destes e do seu impacto, quando incluído na alimentação diária de um doente celíaco, nos parâmetros antropométricos e, consequentemente, no estado de saúde deste. O objetivo do estudo é a avaliação da ingestão alimentar e nutricional de crianças e adolescentes sob DIG, com diagnóstico de DC e relacioná-la com parâmetros antropométricos, nomeadamente: Índice de Massa Corporal (IMC), massa gorda e massa livre de gordura.
Métodos: Foi realizado um estudo prospetivo na Consulta Externa de Pediatria do Centro Hospitalar
Universitário de São João (CHUSJ), com 45 doentes celíacos em idade pediátrica que mantém uma DIG. Os parâmetros antropométricos foram avaliados com recurso à impedância bioelétrica e a ingestão alimentar foi avaliada com a recolha de questionários alimentares. Foi aplicado o questionário alimentar das 24h anteriores durante a realização da consulta externa de nutrição, e o diário alimentar de três dias consecutivos foi realizado pelos próprios doentes, e, posteriormente enviado por e-mail. Seguidamente, os dados obtidos nos questionários foram analisados no software Nutrium, e posteriormente tratados com recurso ao programa estatístico IBM SPSS ® (Statistical Package for the Social Sciences, SPSS Inc, Chicago), versão 22.0, de modo a compreender o impacto da DIG na composição corporal dos doentes celíacos. Resultados: A amostra foi constituída por 45 doentes em idade pediátrica de várias faixas etárias e
contou, maioritariamente, com doentes do género feminino. Todos os doentes praticavam uma DIG, observando-se que os resultados obtidos nos questionários, nomeadamente os valores de macronutrientes foram de encontro com os valores da European Food Safety Authority (EFSA). Relativamente aos valores obtidos de micronutrientes, observou-se que se encontram, maioritariamente abaixo das recomendações das Dietary Recommended Intakes (DRI). .Alguns doentes provavelmente consomem de forma esporádica alimentos com glúten, ou omitiram o seu consumo aquando da realização dos questionários alimentares das 24h anteriores ou do preenchimento dos diários alimentares dos 3 dias consecutivos.Considerações finais: Na amostra estudada, a ingestão alimentar é adequada e ajustada às recomendações alimentares. No entanto, contou-se com a participação de um número reduzido de doentes pelo que se deveria aumentar o tamanho amostral e avaliar a composição dos doentes por um período mais longo.
Introduction: Celiac Disease (CD) is a chronic and autoimmune inflammatory disease characterized by permanent and glúten intolerance in genetically susceptible individuals. The etiology of CD is multifactorial, with a strong interaction between genetic factors, such as HLA-DQ2 (Human Leukocyte Antigen Class 2), immunological and environmental. The diagnosis of CD is based on clinical laboratory evaluation (serological markers) and a biopsy (histological markers). Currently, treatment for CD is based on a lifetime Gluten Free Diet (DIG). Ingestion of gluten foods causes inflammation of the intestinal mucosa, especially atrophy of the intestinal villi, with consequent decrease in the absorption surface and the enzymes necessary for the absorption and compensatory hyperplasia of Lieberkϋhn's crypts. With low absorption, various nutritional deficiencies can occur, including a deficiency of vitamins D, E, B12, iron, calcium and zinc. Despite the simplicity of transforming a gluten diet into a DIG, the development of gluten-free products by industry has been questioned because of their nutritional adequacy and impact when included in a celiac patient's daily diet, anthropometrics and consequently, on health state of this. The objective of study is to evaluate the food and nutritional intake of children and adolescents under DIG diagnosed with CD and to relate it to anthropometric parameters, namely: Body Mass Index (BMI), fat mass and fat free mass. Methods: Prospective study conducted at the Pediatric Ambulatory of the University Hospital Center of São João (CHUSJ), with 45 celiac patients who maintain a DIG. Anthropometric parameters were assessed by bioelectrical impedance and food intake by collecting food questionnaires. The 24-hour food questionnaire was applied during the external nutrition consultation and the three-day food diary was prepared by the patients themselves and sent by email. Subsequently, the data obtained from the questionnaires were analyzed using Nutrium software and further processed in IBM Statistical Package for Social Sciences, SPSS Inc, Chicago, version 22.0, to understand the impact of DIG on body composition of celiac patients. Methods: A prospective study was performed at the Pediatric Outpatient Consultation of the University Hospital Center of São João (CHUSJ), with 45 pediatric celiac patients who maintain a DIG. Anthropometric parameters were evaluated using bioelectrical impedance and food intake was assessed by collecting food questionnaires. The food questionnaire of the previous 24 hours was applied during the external nutrition consultation, and the food diary of three consecutive days was made by the patients themselves, and then sent by e-mail. Subsequently, the data obtained from the questionnaires were analyzed using the Nutrium software, and subsequently processed using the IBM SPSS (Statistical Package for the Social Sciences, SPSS Inc, Chicago), version 22.0, to understand the impact of DIG on body composition of celiac patients. Results: The sample consisted of 45 pediatric patients of various age groups and mostly comprised female patients. All patients practiced a DIG, noting that the results obtained in the questionnaires, namely the macronutrient values were in accordance with the values of the European Food Safety Authority (EFSA. Regarding the values obtained from micronutrients, mostly below Dietary Recommended Intakes (DRI) recommendations. Some patients are likely to consume gluten-free foodssporadically, or omit their intake when completing the 24-hour food questionnaires or completing the 3-day food diaries. Final considerations: In the studied sample, the food intake is adequate and adjusted to the dietary recommendations. However, a small number of patients were involved and therefore the sample size should be increased and the composition of the patients evaluated over a longer period.
Introduction: Celiac Disease (CD) is a chronic and autoimmune inflammatory disease characterized by permanent and glúten intolerance in genetically susceptible individuals. The etiology of CD is multifactorial, with a strong interaction between genetic factors, such as HLA-DQ2 (Human Leukocyte Antigen Class 2), immunological and environmental. The diagnosis of CD is based on clinical laboratory evaluation (serological markers) and a biopsy (histological markers). Currently, treatment for CD is based on a lifetime Gluten Free Diet (DIG). Ingestion of gluten foods causes inflammation of the intestinal mucosa, especially atrophy of the intestinal villi, with consequent decrease in the absorption surface and the enzymes necessary for the absorption and compensatory hyperplasia of Lieberkϋhn's crypts. With low absorption, various nutritional deficiencies can occur, including a deficiency of vitamins D, E, B12, iron, calcium and zinc. Despite the simplicity of transforming a gluten diet into a DIG, the development of gluten-free products by industry has been questioned because of their nutritional adequacy and impact when included in a celiac patient's daily diet, anthropometrics and consequently, on health state of this. The objective of study is to evaluate the food and nutritional intake of children and adolescents under DIG diagnosed with CD and to relate it to anthropometric parameters, namely: Body Mass Index (BMI), fat mass and fat free mass. Methods: Prospective study conducted at the Pediatric Ambulatory of the University Hospital Center of São João (CHUSJ), with 45 celiac patients who maintain a DIG. Anthropometric parameters were assessed by bioelectrical impedance and food intake by collecting food questionnaires. The 24-hour food questionnaire was applied during the external nutrition consultation and the three-day food diary was prepared by the patients themselves and sent by email. Subsequently, the data obtained from the questionnaires were analyzed using Nutrium software and further processed in IBM Statistical Package for Social Sciences, SPSS Inc, Chicago, version 22.0, to understand the impact of DIG on body composition of celiac patients. Methods: A prospective study was performed at the Pediatric Outpatient Consultation of the University Hospital Center of São João (CHUSJ), with 45 pediatric celiac patients who maintain a DIG. Anthropometric parameters were evaluated using bioelectrical impedance and food intake was assessed by collecting food questionnaires. The food questionnaire of the previous 24 hours was applied during the external nutrition consultation, and the food diary of three consecutive days was made by the patients themselves, and then sent by e-mail. Subsequently, the data obtained from the questionnaires were analyzed using the Nutrium software, and subsequently processed using the IBM SPSS (Statistical Package for the Social Sciences, SPSS Inc, Chicago), version 22.0, to understand the impact of DIG on body composition of celiac patients. Results: The sample consisted of 45 pediatric patients of various age groups and mostly comprised female patients. All patients practiced a DIG, noting that the results obtained in the questionnaires, namely the macronutrient values were in accordance with the values of the European Food Safety Authority (EFSA. Regarding the values obtained from micronutrients, mostly below Dietary Recommended Intakes (DRI) recommendations. Some patients are likely to consume gluten-free foodssporadically, or omit their intake when completing the 24-hour food questionnaires or completing the 3-day food diaries. Final considerations: In the studied sample, the food intake is adequate and adjusted to the dietary recommendations. However, a small number of patients were involved and therefore the sample size should be increased and the composition of the patients evaluated over a longer period.
Description
Keywords
Doença celíaca Glúten Dieta isenta de gúten Celiac disease Glúten free diet