Gökhan NERGİZOĞLU, Suat FİTÖZ, Zarife KULOĞLU, Aytaç YAMAN, Arzu Meltem DEMİR, Aydan KANSU

Carotid intima-media thickness and arterial stiffness as early markers of atherosclerosis in pediatric celiac disease

Demir AM, Kuloğlu Z, Yaman A, Fitöz S, Nergizoğlu G, Kansu A. Carotid intima-media thickness and arterial stiffness as early markers of atherosclerosis in pediatric celiac disease. Turk J Pediatr 2016; 58: 172-179.The association between pediatric celiac disease (CD) and atherosclerosis is unknown. Our aim was to investigate whether pediatric CD patients have an increased risk of atherosclerosis. We evaluated the premature atherosclerosis by pulse wave velocity (PWV) and carotid intima-media thickness (cIMT). A total of 37 CD patients (20 girls, mean age 13±3.3 years) and 36 healthy age and sex matched controls were enrolled. Mean duration of CD was 47.1±32.3 months and 40.5% of patients had positive tissue transglutaminase antibody (tTg) IgA. Total cholesterol level was lower in CD (p=0.026) and cIMT was lower in tTg IgA antibody negative CD (p=0.030). cIMT was significantly correlated with tTg IgA antibody positivity (r=0.336; p=0.042). Adherence to strict gluten-free diet is associated with decreased cIMT, suggesting that gluten withdrawal seems to have a beneficial effect on premature atherosclerosis.

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1. Kelly CP, Bai JC, Liu E, Leffler DA. Advances in diagnosis and management of coeliac disease. Gastroenterology 2015; 148: 1175-1186.
2. Viljamaa M, Kaukinen K, Pukkala E, Hervonen K, Reunala T, Collin P. Malignancies and mortality in patients with coeliac disease and dermatitis herpetiformis: 30-year population-based study. Dig Liver Dis 2006; 38: 374-380.
3. Wei L, Spiers E, Reynolds N, Walsh S, Fahey T, MacDonald TM. The association between coeliac disease and cardiovascular disease. Aliment Pharmacol Ther 2008; 27: 514-519.
4. McNeal CJ, Wilson DP, Christou D, et al. The use of surrogate vascular markers in youth at risk for premature cardiovascular disease. J Pediatr Endocrinol Metab 2009; 22: 195-211.
5. Lamotte C, Iliescu C, Libersa C, Gottrand F. Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies. Eur J Pediatr 2011; 170: 719-729.
6. van den Oord SC, Sijbrands EJ, ten Kate GL, et al. Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis 2013; 228: 1-11.
7. Bruno RM, Bianchini E, Faita F, Taddei S, Ghiadoni L. Intima media thickness, pulse wave velocity, and flow mediated dilation. Cardiovasc Ultrasound 2014; 12: 34.
8. Ridha M, Nourse SE, Selamet Tierney ES. Paediatric interventions using noninvasive vascular health indices. Hypertension 2015; 65: 949-955.
9. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55: 1318-1327.
10. Mitchell GF, Hwang SJ, Vasan RS, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 2010; 121: 505-511.
11. Raitakari OT, Juonala M, Kähönen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003; 290: 2277-2283.
12. Corazza GR, Villanacci V. Coeliac disease. J Clin Pathol 2005; 58: 573-574.
13. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006; 95: 194-198.
14. Curcio S, García-Espinosa V, Arana M, et al. GrowingRelated Changes in Arterial Properties of Healthy Children, Adolescents, and Young Adults Nonexposed to Cardiovascular Risk Factors: Analysis of GenderRelated Differences. Int J Hypertens 2016; 2016: 4982676.
15. Reusz GS, Cseprekal O, Temmar M, et al. Reference values of pulse wave velocity in healthy children and teenagers. Hypertension 2010; 56: 217-224.
16. West J, Logan RF, Card TR, Smith C, Hubbard R. Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Aliment Pharmacol Ther 2004; 20: 73-79.
17. Whorwell PJ, Alderson MR, Foster KJ, Wright R. Death from ischaemic heart-disease and malignancy in adult patients with coeliac disease. Lancet 1976; 2: 113-114.
18. Norsa L, Shamir R, Zevit N, et al. Cardiovascular disease risk factor profiles in children with coeliac disease on gluten-free diets. World J Gastroenterol 2013; 19: 5658-5664.
19. De Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther 2013; 38: 162-169.
20. Korkmaz H, Sozen M, Kebapcilar L. Increased arterial stiffness and its relationship with inflammation, insulin, and insulin resistance in coeliac disease. Eur J Gastroenterol Hepatol 2015; 27: 1193-1199.
21. Sari C, Bayram NA, Doğan FE, et al. The evaluation of endothelial functions in patients with coeliac disease. Echocardiography 2012; 29: 471-477.
22. Brar P, Kwon GY, Holleran S, et al. Change in lipid profile in coeliac disease: beneficial effect of glutenfree diet. Am J Med 2006; 119: 786-790.
23. Taavela J, Kurppa K, Collin P, et al. Degree of damage to the small bowel and serum antibody titers correlate with clinical presentation of patients with coeliac disease. Clin Gastroenterol Hepatol 2013; 11: 166-171.
24. Zanini B, Mazzoncini E, Lanzarotto F, et al. Impact of gluten-free diet on cardiovascular risk factors. A retrospective analysis in a large cohort of coeliac patients. Dig Liver Dis 2013; 45: 810-815.
25. Hallert C, Grant C, Grehn S, et al. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther 2002; 16: 1333-1339.
26. Lewis NR, Sanders DS, Logan RF, Fleming KM, Hubbard RB, West J. Cholesterol profile in people with newly diagnosed coeliac disease: a comparison with the general population and changes following treatment. Br J Nutr 2009; 102: 509-513.
27. Martin J, Geisel T, Maresch C, Krieger K, Stein J. Inadequate nutrient intake in patients with coeliac disease: results from a German dietary survey. Digestion 2013; 87: 240-246.
28. Bhattacharya M, Lomash A, Sakhuja P, Dubey AP, Kapoor S. Clinical and histopathological correlation of duodenal biopsy with IgA anti-tissue transglutaminase titers in children with coeliac disease. Indian J Gastroenterol 2014; 33: 350-354.