Benefit of Gluten-free Diet in Older Celiac Disease Patients
Benefit of Gluten-free Diet in Older Celiac Disease Patients
Evidence suggests that the incidence of celiac disease increases with age. Physicians' lack of alertness in the older people may result in a significant delay in diagnosis, as celiac disease is widely deemed to be a condition affecting younger subjects. Indeed, the majority of older celiac disease patients have remained undetected, often due to the absence of symptoms. It is reasonable to assume that, due to long gluten exposure, older patients with untreated celiac disease may be disposed to severe nutritional deficiencies, even when they are seemingly asymptomatic. In particular, the rate of bone loss is accelerated in women after the menopause, likewise in men at the same age. We know that even young and asymptomatic patients with celiac disease may have reduced bone mineral density while untreated, and the condition might be even more evident in older.
On the other hand, a lifelong gluten-free diet is restrictive and may also increase the burden of illness and impairs quality of life. Especially in the older subjects the diet may not be well tolerated, as patients will have adopted lifetime dietary habits which may be hard to break. Moreover, if a gluten-free diet does not necessarily produce any clinical improvement, screen-detected cases may not be motivated to adhere strictly to it. Therefore, to clarify the benefit of serologic screening for celiac disease in older population, a follow-up of the previously undiagnosed patients identified by screening is required.
In this prospective study we evaluated the benefits of active serologic population-based mass screening for celiac disease and subsequent dietary treatment in subjects over 50 years of age. The aim was to establish whether celiac disease should be rigorously searched for in the older people.
Background
Evidence suggests that the incidence of celiac disease increases with age. Physicians' lack of alertness in the older people may result in a significant delay in diagnosis, as celiac disease is widely deemed to be a condition affecting younger subjects. Indeed, the majority of older celiac disease patients have remained undetected, often due to the absence of symptoms. It is reasonable to assume that, due to long gluten exposure, older patients with untreated celiac disease may be disposed to severe nutritional deficiencies, even when they are seemingly asymptomatic. In particular, the rate of bone loss is accelerated in women after the menopause, likewise in men at the same age. We know that even young and asymptomatic patients with celiac disease may have reduced bone mineral density while untreated, and the condition might be even more evident in older.
On the other hand, a lifelong gluten-free diet is restrictive and may also increase the burden of illness and impairs quality of life. Especially in the older subjects the diet may not be well tolerated, as patients will have adopted lifetime dietary habits which may be hard to break. Moreover, if a gluten-free diet does not necessarily produce any clinical improvement, screen-detected cases may not be motivated to adhere strictly to it. Therefore, to clarify the benefit of serologic screening for celiac disease in older population, a follow-up of the previously undiagnosed patients identified by screening is required.
In this prospective study we evaluated the benefits of active serologic population-based mass screening for celiac disease and subsequent dietary treatment in subjects over 50 years of age. The aim was to establish whether celiac disease should be rigorously searched for in the older people.
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