Transplantation: Sharing of donated livers is not equal


of obese patients were poorly adherent compared with 24% of nonobese patients), perhaps reflecting inherent issues in dietary discretion. However, adherence to a gluten-free diet was not correlated overall with final BMI. But, in the subgroup of patients who had a statistically significant change in BMI (≥2 points), those who were poorly adherent to the gluten-free diet were more likely to have lost weight than those who adhered to the diet (15% versus 8%) —which makes sense intuitively. No studies have been carried out on the attitude of patients towards their new diagnosis and how this might influence their dietary adherence and BMI. Although many patients claim strict dietary adherence, we were interested to note that a high rate of patients also admit to intentional dietary transgressions.5 The gluten-free diet requires changes for a patient. They need to learn both what to avoid and what to eat. They need to be provided with information about healthy choices in their diet. However, the number of dietitians who are trained and available to provide such nutritional counseling is limited.6 Some patients will gain weight on the gluten-free diet, becoming overweight or obese. The risk of weight gain needs to be addressed by all members of the patient’s health-care team, including the diagnosing gastroenterologist, the primary care physi cian and the dietitian. Weight control counseling should be part of the nutritional counseling for the gluten-free diet. The gluten-free diet is not an inherently healthy diet; it can be low in fiber, enriched in fat and deficient in B vitamins as a result of the lack of fortification of nonwheat flours.7,8 However, the diet can be made healthier by incorporating healthy grains that do not contain gluten, such as certified gluten-free oats and quinoa.9 Although it seems that overall patients with celiac disease tend to gain weight on a gluten-free diet, some questions remain unresolved: at what weight do patients with celiac disease who are on a gluten-free diet eventually settle? Does obesity have the same implications in the celiac disease population as in the normal population? Physicians need to be involved in the dietary management of their patients—they need to involve experienced dietitians in the care of their patients with celiac disease and remain involved after referral to the dietitian. Finally, they should encourage patients to address the issue of weight gain and obesity. Department of Medicine and Celiac Disease Center, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, Room 936, New York, NY 10032, USA (R. Sonti, P. H. R. Green). Correspondence to: P. H. R. Green

DOI: 10.1038/nrgastro.2012.69

Cite this paper

@article{Freeman2012TransplantationSO, title={Transplantation: Sharing of donated livers is not equal}, author={Richard B. Freeman}, journal={Nature Reviews Gastroenterology &Hepatology}, year={2012}, volume={9}, pages={248-249} }