Dietary intervention eases celiac symptoms in children but not quality of life

The Gluten3S research group launched a dietary intervention with children who had recently been diagnosed with celiac disease. After a year of monitoring, the researchers confirmed that the symptoms had been significantly reduced and alleviated. However, there was no improvement in the poor quality of life the patients had had from the start. The researchers concluded that the difficulties the children face when eating out, and social ignorance made them feel ill at ease.

The moment when celiac individuals receive their diagnosis is usually full of anxiety, questions and worries. And it goes without saying, when this disease is detected in a child. In order to help in this confusing situation and improve the quality of life of celiac individuals, the Gluten3S research group tried out a nutritional intervention with children. As soon as the children were diagnosed, they underwent face-to-face monitoring over a period of one year, and the effect on various parameters was assessed.

By transmitting information about what the children can and cannot eat, by providing personalized tips to improve their eating habits, and by holding cooking workshops, we have helped families in what is initially a period of perturbation for them. And, at the same time, in three monitoring sessions, we took measurements to analyse the development of their symptomatology and quality of life. What we saw is that after one year the diet of the participants had improved significantly and the symptoms had decreased in general. It was more effective than previous interventions, both telephone and online. We concluded that conducting ongoing face-to-face monitoring brings them more benefits and that it is important to start the monitoring when they have just been diagnosed. However, there was no improvement in quality of life and we believe that the role of society in this is important."

Arrate Lasa, researcher, University of the Basque Country (EHU)

On the one hand, the evolution of gastrointestinal symptoms such as indigestion, diarrhea, abdominal pain, constipation, etc. was studied. The research showed that after 12 months' monitoring, participants had fewer gastrointestinal symptoms and their intensity had decreased. "Besides reducing the number of symptoms, it's important to find out whether the remaining symptoms are mild or severe. What we saw is that after one year the symptoms of high intensity had disappeared, and 90% of them were of low intensity. So the benefits are remarkable," said Dr. Lasa.

On the other hand, regarding other non-gastrointestinal symptoms (dermatitis, mouth ulcers, asthma, depression, etc.), the results showed an overall decrease in all of them. In some cases, the improvements were also found to be highly significant. For example, the presence of anaemia and headaches had decreased significantly. And the fatigue of the participants had also decreased significantly; 40% in the children who had just been diagnosed were suffering from fatigue whereas a year later it was 15%. "It is important to note that celiac disease does not only cause gastrointestinal symptoms. In addition to symptoms such as abdominal pain or diarrhoea, it should be taken into account that it also has other effects and is closely related, for example, to mental health. In many situations celiac individuals find it very difficult to integrate into society, they feel strange because they have to eat differently, they become isolated. And as a result, they suffer from depression and anxiety," reported Arrate Lasa.

Social awareness is key to improving the quality of life of celiac individuals

The EHU study also analysed the quality of life of children with celiac disease and in the assessment it was found to be poor. In fact, on a scale of 100 points, with 100 being the lowest score, the participants gave 60 points to their quality of life, both at the beginning and by the 12th month. In other words, the initial situation was not good and, after receiving a year of nutritional follow-up, no improvement was noticed.

"What this shows is that the well-being of celiac individuals does not depend on a gluten-free diet alone. The social side affects them a lot. The only treatment for individuals with celiac disease is to stop eating gluten and deal with it 5 times a day in each meal. What is more, gluten is present in many foods and food that is safe can be very easily contaminated. With today's lifestyle we often eat out and this causes problems for celiac individuals. They see that society is not educated, they do not trust those who serve them and they feel ill at ease," explained Arrate Lasa.

So the researchers in the Gluten3S group of the University of the Basque Country (EHU) stressed that it is essential to promote social awareness: "Our research made it clear that nutritional interventions and ongoing monitoring are necessary. So we have to continue working with celiac individuals. But we cannot work exclusively with those who have the disease. In order to improve their quality of life and inclusion it is essential to spread knowledge about the disease and the gluten-free diet across society. We still have a lot to do to educate and involve the general population."