Micronutrient deficiencies in patients with celiac disease: A systematic review and meta-analysis.

2025-01
International journal of immunopathology and pharmacology 39
- Saad Lamjadli
- Ider Oujamaa
- Ikram Souli
- Fatima Ezzohra Eddehbi
- Nadia Lakhouaja
- Bouchra M'raouni
- Abdelmouine Salami
- Morad Guennouni
- Moulay Yassine Belghali
- Raja Hazime
- Brahim Admou

PubMed: 39959924
DOI: 10.1177/03946320241313426

Study Design

Type: Meta-Analysis
Population: patients with celiac disease
Methods: Meta-analysis performed in accordance with the PRISMA guidelines; literature searches of multiple databases retrieved 4140 studies, of which 45 were selected; Risk of Bias performed in accordance with the STROBE checklist

This study aimed to characterize micronutrient deficiencies, including iron, ferritin, folic acid, vitamin D, zinc (Zn), vitamin B₁₂, and copper, in patients with celiac disease, and evaluated the effects of these deficiencies on selected hematological parameters, including hemoglobin and mean corpuscular volume (MCV). Celiac disease (CeD), an immune-mediated disorder affecting the small bowel, is associated with genetic factors and micronutrient deficiencies. This meta-analysis was performed in accordance with the PRISMA guidelines. Literature searches of multiple databases retrieved 4140 studies, of which 45 were selected. Risk of Bias was performed in accordance with the STROBE checklist. Meta-analysis revealed a significant difference in hemoglobin levels between patients with CeD and controls (standardized mean difference (SMD) -0.59 (95% confidence interval (CI) -0.8459 to -0.3382); P = 0.0003). Iron levels were lower in patients with CeD (SMD ≈ -0.4 (95% CI -0.7385 to -0.0407); P = 0.0334), as were ferritin (SMD -0.6358 (95% CI -0.8962 to -0.3755); P = 0.0002), folic acid (SMD -0.5446 (95% CI -0.9749 to -0.1142); P = 0.0187), and vitamin D (SMD -0.4011 (95% CI -0.8020 to -0.0001); P = 0.0499) levels, while Zn levels were significantly reduced (SMD -1.1398 (95% CI -2.0712 to -0.2084); P = 0.0242). No significant differences were found in MCV, or copper or vitamin B₁₂ levels between patients with CeD and controls. This study highlighted significantly higher micronutrient deficiencies in patients diagnosed with CeD than in controls, underscoring the importance of systematic nutritional assessment and multidisciplinary management to address micronutrient deficiencies and minimize negative health impact(s).

Research Insights

Copper→Reduced Copper Level
No significant differences were found in ... copper ... levels between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Copper→Reduced Mean Corpuscular Volume
No significant differences were found in MCV ... between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Iron→Improved Iron Levels
Iron levels were lower in patients with CeD (SMD ≈ -0.4 (95% CI -0.7385 to -0.0407); P = 0.0334)
Effect
Beneficial
Effect size
Moderate
Iron→Increased Hemoglobin Levels
Meta-analysis revealed a significant difference in hemoglobin levels between patients with CeD and controls (standardized mean difference (SMD) -0.59 (95% confidence interval (CI) -0.8459 to -0.3382); P = 0.0003).
Effect
Beneficial
Effect size
Moderate
Iron→Reduced Mean Corpuscular Volume
No significant differences were found in MCV ... between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Vitamin B12→Reduced Mean Corpuscular Volume
No significant differences were found in MCV ... between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Vitamin B12→Reduced Vitamin B12 Level
No significant differences were found in ... vitamin B12 levels between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Vitamin B9→Increased Hemoglobin Levels
Meta-analysis revealed a significant difference in hemoglobin levels between patients with CeD and controls (standardized mean difference (SMD) -0.59 (95% confidence interval (CI) -0.8459 to -0.3382); P = 0.0003).
Effect
Beneficial
Effect size
Moderate
Vitamin B9→Reduced Folic Acid Level
folic acid (SMD -0.5446 (95% CI -0.9749 to -0.1142); P = 0.0187)
Effect
Beneficial
Effect size
Moderate
Vitamin B9→Reduced Mean Corpuscular Volume
No significant differences were found in MCV ... between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Vitamin D→Increased Hemoglobin Levels
Meta-analysis revealed a significant difference in hemoglobin levels between patients with CeD and controls (standardized mean difference (SMD) -0.59 (95% confidence interval (CI) -0.8459 to -0.3382); P = 0.0003).
Effect
Beneficial
Effect size
Moderate
Vitamin D→Reduced Mean Corpuscular Volume
No significant differences were found in MCV ... between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Vitamin D→Reduced Vitamin D Level
vitamin D (SMD -0.4011 (95% CI -0.8020 to -0.0001); P = 0.0499)
Effect
Beneficial
Effect size
Moderate
Zinc→Increased Hemoglobin Levels
Meta-analysis revealed a significant difference in hemoglobin levels between patients with CeD and controls (standardized mean difference (SMD) -0.59 (95% confidence interval (CI) -0.8459 to -0.3382); P = 0.0003).
Effect
Beneficial
Effect size
Moderate
Zinc→Reduced Mean Corpuscular Volume
No significant differences were found in MCV ... between patients with CeD and controls.
Effect
Neutral
Effect size
Small
Zinc→Reduced Zinc Level
Zn levels were significantly reduced (SMD -1.1398 (95% CI -2.0712 to -0.2084); P = 0.0242)
Effect
Beneficial
Effect size
Large