Imad Absah, M. D., discusses a recently published review in the Journal of Pediatric Gastroenterology & Nutrition about fat-soluble vitamin deficiencies in pediatric patients with newly diagnosed celiac disease.
Celiac disease affects the small intestine and has been linked to low vitamins and micronutrients in adults. This is especially true of fat-soluble vitamins such as vitamins A, D, E, and K and zinc. The researchers of this study didn't know if pediatric patients would have low vitamin levels and it wasn't clear who should be checked for low vitamin levels when doctors made a new diagnosis of celiac disease.
This study is a retrospective study. The researchers looked back at medical records between 1994 and 2012, and looked at all new patients, specifically children, who had been recently diagnosed with celiac disease and had their vitamin levels checked. The researchers were looking at the fat-soluble vitamins which can be directly measured except for vitamin K. Vitamin K can be indirectly measured by growth room which is a marker of clotting efficiency in the blood.
83 patients had vitamin levels measured at the same time of diagnosis. 51 of the patients were female and 32 were male. It is not common for new patients to have their vitamin levels checked. The physicians may check vitamin levels if they feel the patients are sicker, have malabsorption symptoms, or to make sure their vitamin levels are fine. Surprisingly, very few of the patients had low vitamin levels. All of the patients had normal vitamin A levels, only 2 patients had low vitamin E levels, at least 2 patients had typical malabsorption symptoms, and only 9% had low vitamin D levels. 6% of the patients had indirect signs of low vitamin K levels.
The results show that it's uncommon to have low vitamin levels in children with newly onset celiac disease. This could be due to the new cereals having fortified vitamins or the common use of vitamins with infants. It also could be because the presentation of celiac disease is changing and the typical malabsorption symptoms aren't being seen. All of the patients that did have low vitamin levels corrected the levels quickly with vitamin supplements and a gluten-free diet.
Read the full retrospective study online here.
For more information on celiac disease, visit mayoclinic.org/celiacdisease.
Dr. Absah is a pediatric gastroenterologist at Mayo Clinic.