Marano, Antonella THE IMPACT OF NUTRITION IN THE NATURAL HISTORY OF CELIAC DISEASE (NUTRICEL). [Tesi di dottorato]

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Abstract

Since celiac disease (CD) and obesity displayed a parallel rise during the recent decades, we hypothesised that a metabolic overload could also contribute to the onset and the development of CD. On this basis, we aimed to dissect the role of body density and of the adipose tissue in CD progression from potential CD (PCD) to active CD (ACD), and to investigate nutritional status, dietary habits, and inflammatory markers in different stages of CD. To address our objectives, we employed a combined approach consisting of a retrospective longitudinal study and a prospective cross-sectional study. In line with our hypothesis, our retrospective study highlighted that, even without defining a clinical condition of overweight or obesity, the body density could help predict who among PCD would develop villous atrophy over time, thus advancing a role for the adipose tissue in CD progression. The potential inflammatory role of the adipose tissue is further supported by the evidence that at diagnosis, PCD who will progress to villous atrophy already have a proinflammatory adipokine signature, in contrast with patients who will progress toward reversion of the serology who instead have an anti-inflammatory signature. The prospective part of the study suggest that a higher caloric intake and a higher consumption of pro-inflammatory nutrients may be associated with the loss of immune tolerance to gluten, while a higher intake of anti-inflammatory nutrients, and the Mediterranean diet may play a protective role against the development of full-blown disease. Overall, this study underscores the importance of a healthy and balanced diet possibly to prevent the onset of CD autoimmunity but also, advances the possibility that anti-inflammatory dietary regimens may be suggested to PCD to prevent progression to full-blown disease.

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