Patient preferences in managing zinc deficiency in celiac disease: Insights to inform future clinical trial design

BackgroundZinc deficiency (ZD) is one of the most prevalent nutritional deficiencies reported in celiac disease (CeD). Oral supplementation and dietary modifications are the primary strategies for addressing it. However, it is unclear whether individuals with CeD would prefer to make additional dietary modifications or opt for supplementation to treat ZD.AimThis study aimed to explore patient preferences for the treatment of ZD.MethodsAdult patients (≥18 years) with a confirmed diagnosis of CeD who were already adopting a gluten-free diet (GFD) and had untreated ZD were recruited from the Adult Celiac Disease Clinic at McMaster University. After providing informed consent, participants completed study questionnaires at baseline and three months after initiating zinc supplementation. Data were collected using REDCap. Statistical analyses were performed using IBM SPSS software (V22, Chicago, USA).ResultsFrom March 2022 to January 2024, 44 participants were enrolled in the study. All completed baseline questionnaires, of them 25 (57%) completed questionnaires at follow-up. At baseline, 34% of participants preferred to treat nutrient deficiencies through dietary changes, compared with 28% at follow-up. Plasma zinc level normalized in all participants after 3 months of supplementation. At follow-up, the proportion of participants with significant gastrointestinal symptoms increased from 72% at baseline to 80% (<i>p = </i>0<i>.</i>01).ConclusionsOne-third of patients with CeD preferred to manage nutrient deficiencies through dietary modifications. A zinc-optimized GFD may represent a promising approach to address zinc deficiency in this population. These findings provide preliminary evidence to inform the design of future randomized clinical trials.