Association of Lipid Profile and Atherogenic Indices With Dietary Adherence in Paediatric Coeliac Disease

AIM: The association of adherence to a gluten-free diet (GFD) on lipid metabolism and cardiovascular risk markers in paediatric coeliac disease (CD) remains incompletely understood. This study aimed to evaluate lipid profile parameters and atherogenic indices according to dietary adherence in children with CD. METHODS: Children aged 3-18 years with CD were retrospectively evaluated. GFD adherence was assessed using clinical findings, serology, and patient and/or parental reports. Lipid parameters and atherogenic indices were compared according to GFD adherence. Multivariable linear regression analysis was performed to evaluate the association between GFD adherence and high-density lipoprotein cholesterol (HDL-C) after adjustment for age, sex, and BMI. RESULTS: A total of 149 children included in the study; 106 (71.1%) were classified as diet-adherent and 43 (28.9%) as diet-nonadherent. HDL-C levels were significantly higher in children adhering to a GFD (55.3 vs. 46 mg/dL, p < 0.001), whereas total cholesterol, low-density-lipoprotein-cholesterol, triglyceride, and glucose levels were similar between groups. Castelli-Risk-Index-I, Castelli-Risk-Index-II, Atherogenic-Coefficient, and Atherogenic-Index-of-Plasma were significantly lower in children adhering to a GFD (all p < 0.05). Triglyceride-Glucose-Index did not differ between groups (p = 0.430). Dietary adherence remained an independent predictor of higher HDL-C levels after adjustment for age, sex, and body-mass-index (B = 8.253, 95% CI: 3.972-12.534, p < 0.001). CONCLUSIONS: GFD adherence was associated with higher HDL-C levels and a more favourable profile of lipid-derived atherogenic indices in children with CD. These findings suggest an association between adherence to a GFD and HDL-C-related lipid parameters; however, prospective studies are needed to determine the temporal and causal relationships between dietary adherence and metabolic outcomes.