Alimentary Pharmacology and Therapeutics Letter to the Editors indicate patients without evidence of partial villous atrophy.4 Finally, we acknowledge that there are no universally accepted guidelines to monitor adherence to dietary advice in CD.4 We assume that all the patients were compliant with GFD at follow-up. However, we feel that limiting the follow-up to the measurement of anti-tissue transglutaminase antibodies and dietetic consultation makes it hard to allow for full response of the disease to GFD.5 In conclusion, one may wonder whether metabolic syndrome was associated with the prescription of a GFD in patients where it was not mandatory, or simply the tale of an immune condition poorly responding to mandatory dietetic treatment, as an alternative. Eventually, this paper might raise concerns on the potential harm of a GFD when the prescription is not mandatory.
Letter: metabolic syndrome in patients with coeliac disease on a gluten-free diet – authors’ reply R. Tortora & A. Rispo Gastroenterology – Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy. E-mail: [email protected] doi:10.1111/apt.13137
SIRS, First, we sincerely appreciated the interest and comments on our paper by Chiarioni and Colleagues.1, 2Our work (and the final statistical analysis) included only patients affected by “classical” and “non-classical” coeliac disease according to the Oslo definitions.3 So, even if the definition of ‘potential’ coeliac disease was reported in the Methods, no subject with potential coeliac disease (Marsh 0-1) was considered in the analysis. Starting from this consideration, our group of patients with coeliac disease can be considered ‘homogeneous’ and gluten-free diet (GFD) was prescribed in the context of a ‘mandatory’ indication. The previous experience by Chiarioni and De Marchi,4 reporting different results with respect to ours, in terms of lipid profile pre- and post-GFD, was very clear in our
796
ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Tortora R, Capone P, de Stefano G, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther 2015; 41: 352–9. 2. Rybak A, Cukrowska B, Socha J, Socha P. Long term follow up of celiac disease—is atherosclerosis a problem? Nutrients 2014; 6: 2718–29. 3. de Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther 2013; 38: 162–9. 4. Ludvigsson JF, Lefner DA, Bai JC, et al. The Oslo definitions for celiac disease and related terms. Gut 2013; 62: 43–52. 5. Lanzini A, Lanzarotto F, Villanacci V, et al. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment Pharmacol Ther 2009; 29: 1299–308.
minds and, in effect, we (briefly) discussed it in the paper. However, we think that the wide population included in our study tends to give more robust results compared with that of previous papers, including small series. Finally, we are not surprised by our results showing that GFD (even after considering its high glycaemic index) returns the risk of metabolic syndrome of patients with coeliac disease almost to that reported in the general population.
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Chiarioni G, De Marchi S, Prior M, Arosio E. Letter: metabolic syndrome in patients with coeliac disease on a gluten-free diet: the old story of chicken and egg? Aliment Pharmacol Ther 2015; 41: 795–6. 2. Tortora R, Capone P, De Stefano G, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther 2015; 41: 352–9. 3. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 14: 43–52. 4. De Marchi S, Chiarioni G, Prior M, et al. Young adults with coeliac disease may be at increate risk of early atherosclerosis. Aliment Pharmacol Ther 2013; 38: 162–9.
Aliment Pharmacol Ther 2015; 41: 789–796 ª 2015 John Wiley & Sons Ltd
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letter: metabolic syndrome in patients with coeliac disease on a gluten-free diet – authors’ reply R. Tortora & A. Rispo Gastroenterology – Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy. E-mail: [email protected] doi:10.1111/apt.13137
SIRS, First, we sincerely appreciated the interest and comments on our paper by Chiarioni and Colleagues.1, 2Our work (and the final statistical analysis) included only patients affected by “classical” and “non-classical” coeliac disease according to the Oslo definitions.3 So, even if the definition of ‘potential’ coeliac disease was reported in the Methods, no subject with potential coeliac disease (Marsh 0-1) was considered in the analysis. Starting from this consideration, our group of patients with coeliac disease can be considered ‘homogeneous’ and gluten-free diet (GFD) was prescribed in the context of a ‘mandatory’ indication. The previous experience by Chiarioni and De Marchi,4 reporting different results with respect to ours, in terms of lipid profile pre- and post-GFD, was very clear in our
796
ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Tortora R, Capone P, de Stefano G, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther 2015; 41: 352–9. 2. Rybak A, Cukrowska B, Socha J, Socha P. Long term follow up of celiac disease—is atherosclerosis a problem? Nutrients 2014; 6: 2718–29. 3. de Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther 2013; 38: 162–9. 4. Ludvigsson JF, Lefner DA, Bai JC, et al. The Oslo definitions for celiac disease and related terms. Gut 2013; 62: 43–52. 5. Lanzini A, Lanzarotto F, Villanacci V, et al. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment Pharmacol Ther 2009; 29: 1299–308.
minds and, in effect, we (briefly) discussed it in the paper. However, we think that the wide population included in our study tends to give more robust results compared with that of previous papers, including small series. Finally, we are not surprised by our results showing that GFD (even after considering its high glycaemic index) returns the risk of metabolic syndrome of patients with coeliac disease almost to that reported in the general population.
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Chiarioni G, De Marchi S, Prior M, Arosio E. Letter: metabolic syndrome in patients with coeliac disease on a gluten-free diet: the old story of chicken and egg? Aliment Pharmacol Ther 2015; 41: 795–6. 2. Tortora R, Capone P, De Stefano G, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther 2015; 41: 352–9. 3. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 14: 43–52. 4. De Marchi S, Chiarioni G, Prior M, et al. Young adults with coeliac disease may be at increate risk of early atherosclerosis. Aliment Pharmacol Ther 2013; 38: 162–9.
Aliment Pharmacol Ther 2015; 41: 789–796 ª 2015 John Wiley & Sons Ltd
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
