Efficacy of a High-Iron Dietary Intervention in Women with Celiac Disease and Iron Deficiency without Anemia: A Clinical Trial.
BACKGROUND AND AIM
Iron deficiency without anemia (IDWA) is a common finding in celiac disease (CD) and can also persist in case of good compliance and clinical response to a strict gluten-free diet (GFD). This scenario usually presents in CD women of child-bearing age in whom the imbalance between menstrual iron loss and inadequate iron intake from their diet plays the major role. A recommended approach to this condition is yet to be established. This study aimed to compare, in this subset of patients, the efficacy of a dietary approach consisting of an iron-rich diet against the traditional pharmacological oral-replacement therapy.


MATERIAL AND METHODS
Between February and December 2016, consecutive CD female patients of child-bearing age as referred to our outpatient center with evidence of IDWA (ferritin <15 ng/mL or 15-20 ng/L with transferrin saturation <15%) were enrolled. After the completion of a 7-day weighed food intake recording to assess the usual iron dietary intake, the patients were randomized in two arms to receive a 12-week iron-rich diet (iron intake >20 mg/die) versus oral iron supplementation with ferrous sulfate (FS) (105 mg/day). Blood tests and dietary assessments were repeated at the end of treatment. The degree of compliance and tolerability to the treatments were assessed every month by means of specific questionnaires and symptoms evaluation.


RESULTS
A total of 22 women were enrolled and divided in the diet group (n = 10, age 37 ± 8 years) and in the FS group (n = 12, age 38 ± 10 years). The food intake records demonstrated an inadequate daily intake of iron in all the enrolled subjects. At the end of the treatments, ferritin levels were higher in the FS group (8.5 (5) versus 34 (30.8), p = 0.002). Compliance and tolerability were similar in both treatment groups (89% versus 87%, p = ns).


CONCLUSIONS
These findings did not support any equivalent efficacy of an iron-rich diet compared to a FS supplementation in non-anemic iron-deficient women affected by CD. However, the diet appeared a well-tolerated approach, and adequate dietary instructions could effectively increase the daily iron consumption, suggesting a role in the long-term management of IDWA, especially in patients who do not tolerate pharmacological supplementation.
['Scricciolo|Alice|A|0000-0002-4014-4573', 'Elli|Luca|L|0000-0002-0873-0759', 'Doneda|Luisa|L|', 'Bascunan|Karla A|KA|0000-0002-3759-2121', 'Branchi|Federica|F|0000-0001-9217-8241', 'Ferretti|Francesca|F|0000-0002-6445-0954', 'Vecchi|Maurizio|M|', 'Roncoroni|Leda|L|']
D000328:Adult D018798:Anemia, Iron-Deficiency D002446:Celiac Disease D055050:Diet, Gluten-Free D019587:Dietary Supplements D005260:Female D005293:Ferritins D005296:Ferrous Compounds D006801:Humans D007501:Iron D000090463:Iron Deficiencies D019266:Iron, Dietary D008875:Middle Aged D015596:Nutrition Assessment D009752:Nutritional Status D011446:Prospective Studies D011795:Surveys and Questionnaires
women Celiac disease iron deficiency without anemia gluten-free diet iron supplementation dietary iron