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Doença celíaca e diabetes mellitus tipo 1 em pediatria : impacto da dieta gluten-free
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Abstract(s)
A doença celíaca (DC) é mais prevalente em doentes com diabetes mellitus tipo 1 (DMT1) do que na população geral. Na maioria dos casos, o diagnóstico da DMT1 antecede o da DC, que geralmente ocorre nos 5 anos seguintes. Sendo a maioria dos doentes assintomática ou com sintomas ligeiros, o rastreio periódico da DC neste grupo é imprescindível, recomendando-se o rastreio da DC em doentes pediátricos com DMT1 no momento do diagnóstico da DMT1 e após 2 e 5 anos, no mínimo. O conhecimento sobre os efeitos da dieta gluten-free (GF) em doentes pediátricos com duplo diagnóstico continua limitado e controverso. Os produtos GF comercializados têm um conteúdo inferior em proteína e superior em gordura e sal, porém não se verificam défices nutricionais notórios nas crianças sob esta dieta, para além de um possível défice de zinco, selénio e magnésio. A adesão à dieta GF em pediatria é inferior nos doentes com duplo diagnóstico (inferior a 59%), comparativamente a doentes apenas celíacos (73%). A dieta GF parece ter inúmeros benefícios, além das normalizações clínica, serológica e histológica da DC, como o melhor controlo metabólico da DMT1, a possível prevenção das suas complicações crónicas e a melhoria da qualidade de vida de doentes sintomáticos, no bem-estar geral e na qualidade de vida associada à diabetes. A associação da DC à DMT1 não parece alterar as qualidades de vida geral e a associada à diabetes ou a qualidade de vida da família. O envolvimento familiar é essencial na correta adesão à dieta GF, principalmente na adolescência.
Celiac disease (DC) is more prevalent among patients with type 1 diabetes mellitus (DMT1) than in general population. More frequently, the diagnosis of DMT1 precedes the one of DC, which usually occurs within the following 5 years. Since the majority of patients is asymptomatic or presents with mild symptoms, the periodic screening of DC in this group is crucial, with current recommendations advising the screening in the pediatric population at the time of the diagnosis of DMT1 and 2 and 5 years after, at least. Evidence about the effects of the gluten-free (GF) diet in children with both diseases remain scarce and arguable. Despite the GF products commercially available having lower contents of protein and higher of fat and salt, no significant nutritional deficits were perceived in children on this diet, besides a possible deficit in zinc, selenium and magnesium. The GF diet adherence is lower in children with both diseases (less than 59%), comparing with celiac children (73%). GF diet appears to have innumerous benefits, besides the clinical, serological and histological resolution, for instance a better metabolic control of DMT1, a possible prevention of its chronic complications and a better quality of life of symptomatic patients, on well-being and diabetes-specific quality of life. The association of DC and DMT1 didn’t seem to impact negatively the generic quality of life, the diabetes-specific quality of life or the family’s. Family participation in the disease management is imperative on a strict GF diet adherence, specially in adolescence.
Celiac disease (DC) is more prevalent among patients with type 1 diabetes mellitus (DMT1) than in general population. More frequently, the diagnosis of DMT1 precedes the one of DC, which usually occurs within the following 5 years. Since the majority of patients is asymptomatic or presents with mild symptoms, the periodic screening of DC in this group is crucial, with current recommendations advising the screening in the pediatric population at the time of the diagnosis of DMT1 and 2 and 5 years after, at least. Evidence about the effects of the gluten-free (GF) diet in children with both diseases remain scarce and arguable. Despite the GF products commercially available having lower contents of protein and higher of fat and salt, no significant nutritional deficits were perceived in children on this diet, besides a possible deficit in zinc, selenium and magnesium. The GF diet adherence is lower in children with both diseases (less than 59%), comparing with celiac children (73%). GF diet appears to have innumerous benefits, besides the clinical, serological and histological resolution, for instance a better metabolic control of DMT1, a possible prevention of its chronic complications and a better quality of life of symptomatic patients, on well-being and diabetes-specific quality of life. The association of DC and DMT1 didn’t seem to impact negatively the generic quality of life, the diabetes-specific quality of life or the family’s. Family participation in the disease management is imperative on a strict GF diet adherence, specially in adolescence.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Doença celíaca Diabetes mellitus tipo 1 Dieta gluten-free Controlo metabólico Qualidade de vida Pediatria