Kocaeli Med J. 2019; 8(3): 80-88 | DOI: 10.5505/ktd.2019.48379

Frequency of Vitamin D Deficiency and Osteoporosis in Celiac Patients

Muhammed Kaya¹, Selen Þipal², Umut Polat³, Mesut Sezikli^4
1Hitit University Erol Olcok Research and Training Hospital, Department of Internal Medicine
²Van Training and Research Hospital, Department of Internal Medicine
³Emet Dr. Fazýl Doðan State Hospital, Department of Internal Medicine
⁴Derince Training and Research Hospital, Department of Gastroenterology

INTRODUCTION: Celiac is an autoimmune disease that presents itself due to intake of gluten in people genetically predisposed, a typical symptom of which includes inflammation in intestines. Vitamin deficiencies and osteoporosis are also important findings. The aim in this study to investigate the frequency of vitamin D deficiency and osteoporosis in celiac patients.
METHODS: 80 patients between the ages of 18 and 65 diagnosed with celiac disease as well as a healthy group of 45 people were included in this study. The demographical information, anthropometric, hemogram, biochemical, vitamin B12, vitamin D, folate and ferritin measurements were acquired from the hospital database. In addition, TTG IgA, TTG IgG, and DEXA results were obtained for the patients in the study. Patients with celiac disease were divided into two groups based on the TTG antibody test determining whether they are compatible with gluten-free diet or not. The results concerning the patients compatible and non-compatible with gluten-free diet as well as healthy control group are analyzed using the SPSS 22 program.
RESULTS: The patients compatible with the gluten-free diet as well as those that are not and the healthy group share the same characteristic in terms of age, gender, and tobacco use. The results indicate that weight, liver functions, and hemogram and anemia parameters deteriorated for patients not compatible with the gluten-free diet, whereas the same measurements are on par with the healthy group for those that are compatible with the gluten-free diet. In this study, the vitamin D deficiency in the patient group is high (73.8%), though is not statistically different than the healthy group. 55.1% of patients have osteopenia and 17.9% have osteoporosis. Only 8.9% of patients compatible with gluten-free diet are diagnosed with osteoporosis, compared to 30.3% in non-compatible patients, which is a statistically significant difference.
DISCUSSION AND CONCLUSION: Hemogram, folate, ferritin and biochemical measurements deteriorate significantly in patients that are not compatible with gluten-free diet. In patients with and without celiac disease, a high rate of vitamin D deficiency has been shown and no association between disease and deficiency has been found. Osteoporosis is frequently seen in patients with celiac disease and increases significantly in patients with non-compliant of gluten-free diet.

Keywords: Celiac disease, vitamin D, osteoporosis, gluten-free diet

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Çölyak Hastalarýnda D Vitamini Eksikliði ve Osteoporoz Sýklýðý

Muhammed Kaya¹, Selen Þipal², Umut Polat³, Mesut Sezikli^4
1Hitit Üniversitesi Erol Olçok Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý Kliniði
²Van Bölge Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý Kliniði
³Emet Dr. Fazýl Doðan Devlet Hastanesi, Ýç Hastalýklarý Kliniði
⁴Derince Eðitim ve Araþtýrma Hastanesi, Gastroenteroloji Kliniði

GÝRÝÞ ve AMAÇ: Çölyak Hastalýðý genetiði yatkýn bireylerde diyette gluten proteininin alýmýyla ortaya çýkan, ince barsaklarda inflamasyonla seyreden otoimmün bir hastalýktýr. Vitamin eksiklikleri ve osteoporoz da önemli bulgularýndandýr. Çalýþmamýzda takipli çölyak hastalarýnda vitamin D eksikliði ve osteoporoz sýklýðýný deðerlendirmek amaçlanmýþtýr.

YÖNTEM ve GEREÇLER: Çalýþmamýza kliniðimizde çölyak tanýsýyla takip edilen 18-65 yaþ arasý 80 hasta ve kontrol grubu olarak 45 saðlýklý birey dâhil edilmiþtir. Her iki grubun demografik özellikleri, antropometrik ölçümleri, hemogram, biyokimya, vitamin B12, folat, ferritin, vitamin D düzeyleri ile hasta gruba ait TTG IgA, TTG IgG ve KMD sonuçlarý sistemde kayýtlý verilerden elde edilmiþtir. Çölyak hastalarý TTG antikor pozitifliðine göre glutensiz diyete uyumlu ve uyumsuz olarak iki gruba ayrýlmýþtýr. Diyete uyumlu ve uyumsuz çölyak hastalarý ile saðlýklý kontrol grubuna ait veriler karþýlaþtýrýlarak SPSS 22 istatistik programý ile analiz edilmiþtir.

BULGULAR: Diyete uyumlu ve uyumsuz hasta gruplarý ile kontrol grubu yaþ cinsiyet ve sigara kullanýmý açýsýndan benzer özelliklerdedir. Diyete uyumsuz çölyak hastalarýnda vücut aðýrlýðý, karaciðer fonksiyon testleri, hemogram ve anemi parametrelerinin kötüleþtiði, diyete uyum gösteren hastalarda ise saðlýklý popülasyona benzer olduðu görülmektedir. Çalýþmamýzda çölyaklýlarda vitamin D eksikliði yüksek oranda (%73,8) saptanmýþ, ancak saðlýklý kontrollerden farksýz bulunmuþtur. Çölyak hastalarýnýn %55,1’inde osteopeni, %17,9’unda osteoporoz saptanmýþtýr. Glutensiz diyete uyumlu hastalarda %8,9 olan osteoporoz oraný diyete uymayan hastalarda %30,3 olarak saptanmýþ ve anlamlý ölçüde artýþ görülmüþtür.

TARTIÞMA ve SONUÇ: Diyete uyumsuz hastalarda hemogram, biyokimya, folat ve ferritin parametreleri anlamlý ölçüde bozulmaktadýr. Vitamin D eksikliði hem çölyaklýlarda hem de saðlýklý popülasyonda sýk görülmektedir ancak çölyak hastalýðý ve diyet uyumu ile iliþkisi saptanamamýþtýr. Osteoporoz, çölyak hastalarýnda sýk görülmekte olup diyete uyumsuz hastalarda anlamlý ölçüde artmaktadýr.

Anahtar Kelimeler: Çölyak hastalýðý, Vitamin D, Osteoporoz, Glutensiz diyet

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