Body Mass Index (BMI) in coeliac disease (CD); the relationship between BMI and coexistent autoimmunity in a cohort of CD patients
P. Dominguez Castro1, G. Harkin3, M. Hussey4, B. Christopher5, C. Kiat3, J. Liong Chin1, V.Trimble1, T. Martin2, D. McNamara4, P. MacMathuna2, B. Egan6, D. Kevans1, NP. Kennedy1, R. Farrell5, N. Mahmud1, V. Byrnes3, R. McManus1
1Institute of Molecular Medicine & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, 2Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, 3Department of Clinical Medicine, University College Hospital Galway, 4Department of Clinical Medicine, The Adelaide and Meath Hospital, Dublin, 5Connolly Hospital Blanchardstown, Dublin, 6Department of Clinical Medicine, Mayo General Hospital, Castlebar, Co. Mayo
Coeliac disease (CD) is an immune-mediated condition which can only be treated at present by strict adherence to a gluten free diet (GFD) (1). It is well reported in the literature that many CD patients can have a normal or high BMI at diagnosis (2). Studies have also shown that CD patients’ BMIs tend to increase on the GFD (2, 3). The co-occurrence of CD with other autoimmune conditions has been well described (4). High BMIs have been linked to increased risk to develop autoimmune conditions (5).
The aim of this study is to explore CD patients’ BMI at diagnosis and after a period on the GFD and its role in the development of co-existent autoimmune conditions.
Retrospective analysis of medical charts from a cohort of coeliac patients (n=565) (median age 57 years, range 16-88 years).
BMIs at diagnosis were available for 264 patients; 5.7% of these patients were underweight (BMI <18.5 kg/m2), 53.4% had a normal BMI (≥18.5-24.9 kg/m2), and 40.9% were either overweight or obese (≥25 kg/m2). BMIs were available at diagnosis and in the most recent outpatient visit for 190 patients. The median time since diagnosis for these patients was 7.5 years. There was a statistically significant difference between the BMI at diagnosis (median=23.45 kg/m2) and the BMI in the most recent outpatient visit (median=25.05 kg/m2) (p<0.001). The most recent BMI was available for 293 patients, 106 of these patients (36.2%) had a co-existent autoimmune condition. There was a statistically significant difference in the percentage of people with a co-existent autoimmune condition when patients were divided into those with a BMI <25 kg/m2 and ≥25 kg/m2 (28.2% and 42.6% respectively) (p=0.014).
Most of the patients in our sample had a normal or high BMI at diagnosis. BMI’s seem to increase with the adoption of the GFD, the median in our study increased from the normal range to the high range. There seems to be a relationship between high BMI and the development of a co-existent autoimmune condition in CD patients in our sample. In these patients with a high predisposition to autoimmunity, dietetic and nutritional input over time after diagnosis seems to be pivotal.