One of these belonged to the control group and one to CD group, reflecting that almost all patients in all groups were within the normal range for Z-score in the bone mineral density, without any statistical difference. Our data show that all laboratorial parameters measured were similar in all groups, with only three patients with T-score compatible with osteopenia by densitometry: one patient of DM group and other two female participants, postmenopausal, aged 48 and 57 years old. We also assessed bone metabolism as shown in Table 3. Statistically significant differences are indicated in bold. The average dose of insulin was 0.69☐.37 and 0.61☐.19 units per kg per day, group DMCD and CD, respectively. All patients with diabetes were on intensive multiple doses insulin therapy, just one patient at DMCD group was with continuous subcutaneous insulin infusion. The Institutional Review Board at Hospital das Clinicas approved these studies all participants provided signed, informed consent. We adopted as inclusion criteria: (1) adult individuals aged 18–59 years (2) type 1 diabetes diagnosed by presence of antibodies anti-glutamic acid decarboxylase or anti-islet or C-peptide <0.5 ng ml −1 or dependence on insulin since diagnosis of the disease (3) CD confirmed by antibodies, anti-endomysial antibodies (anti-EMA) or anti-transglutaminase antibody positives and typical histologic alterations on intestinal biopsy. They were recruited from Hospital das Clinicas da Faculdade de Medicina, Universidade São Paulo, endocrinology and gastroenterology outpatient clinics, although healthy participants were recruited from the nutrition and dietetics division. Sixty patients controlled by sex, age and BMI were stratified by previous diagnosis in four groups: T1DM and CD (DMCD group) T1DM (DM group) CD (CD group) or healthy participants (HC group). To evaluate the nutritional status, and characterize usual dietary intake and impact on QoL of individuals with T1DM associated with CD, without biases related to sex, age and body mass index (BMI), we used the parameters of the 15 patients enrolled in the DMCD group to match with those of participants from the other three groups. Therefore, the aim of the study was to evaluate the QoL of individuals with the association of T1DM and CD, and to characterize their nutritional status, nutritional behavior and deficiencies, comparing it with those with only one disease (T1DM or CD) and healthy controls 11, 12 Despite the high prevalence of the association between T1DM and CD, the repercussion of dietary changes imposed by both diseases on QoL has been poorly evaluated. 9, 10 Initially, the QoL of celiac patients is affected by diet restriction however, it improves ~1 year after the introduction of GFD, even in those with a partial adherence. Some studies have shown an improvement in quality of life scores (QoL) for those patients with T1DM after initiating carbohydrate counting and intensive insulin therapy, but the need for full-time attention to the disease for a long time may deteriorate their QoL. 4, 5, 6 Overall, individuals with adequate adhesion to the gluten-free diet (GFD) tend to consume smaller amounts of fibers, iron, calcium, folic acid and vitamin B12. The appropriateness of nutrients is related to the availability, composition of gluten-free food, cultural aspects, access to ‘new diets' and specific nutritional recommendations for each population. Proper gluten restriction results in a recovery of the CD enteropathy, despite conflicting results about the adequacy of daily requirements of micronutrients and macronutrients. Similarly, treatment for CD is based on the dietary therapy, with restriction of wheat, rye and barley, responsible for the immune system activation and intestinal damage. 2 Hence, the medical prescription of multiple doses of insulin and carbohydrate counting showed better glycemic control in individuals with DM1, avoiding the glucose restriction and the negative impact of dietary restriction. 1 T1DM treatment is based on the regular physical activity, and nutritional and insulin therapy. Both diseases have genetic patterns linked to HLA-DQ2 and HLA-DQ8, resulting in a reported prevalence of CD in T1DM five to seven times higher than in the general population. Type 1 diabetes mellitus (T1DM) and celiac disease (CD) are autoimmune diseases caused by the interactions of genetic and environmental factors.
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