Review for 10.1186/s12876-024-03446-x (2024)

Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 1 Date: 11 Jul 2024
Reviewer's report:
Firstly, I would like to commend the authors for their dedication to exploring the intersection of
celiac disease and obesity. The topic is both relevant and significant, given the rising prevalence
of obesity worldwide and the ongoing need to understand how it intersects with various chronic
conditions, including celiac disease. The authors have put considerable effort into conducting
a meta-analysis, which is a valuable tool for synthesizing existing research and drawing more
robust conclusions.
However, I have a few concerns and suggestions that I believe would strengthen the manuscript:
Abstract:
- The abstract does not specify whether the weight percentages provided from the meta-
analysis are at the time of celiac disease diagnosis, after diagnosis, or all comers. Including this
information is important context and would have implications for how this study is relevant to
clinical care.
Introduction:
- The introduction mentions the hypothesis of compensation in the distal intestine in celiac
disease patients as a mechanism for obesity, citing review articles. I would recommend
rephrasing this sentence to suggest that this is a theoretical concept rather than a well-established
fact.
- There is a sentence about the long-term complications of celiac disease being preventable based
on findings of this study. This is somewhat misleading as there is evidence that the obesity or
being overweight may actually increase after the initiation of a gluten-free diet. It would be
more beneficial to discuss the bias against checking individuals for celiac disease due to their
weight and the importance of monitoring patients’ post-diagnosis to prevent weight gain and
complications such as fatty liver disease.
Methods:
- The manuscript does not specify the ages of the patients included in the studies (adults or
children) or whether the weight data was collected before or after the diagnosis of celiac disease.
This information is crucial for understanding the study population and interpreting the results
accurately.
Results:
- There is a discrepancy in the characteristics of the study participants. Initially, it is mentioned
that the studies are from 2003-2022, but later it is stated as 1995-2021. This inconsistency needs
to be clarified.
-It is crucially important to clarify the characteristics of the celiac disease population included in
this study. Specifically, clarity is needed on whether the percentages given for BMI categories
pertains to the time of celiac diagnosis, after diagnosis and initiation of a gluten-free diet, and
whether the subjects were children or adults.
Discussion:
- The discussion should place more emphasis on the delay and misdiagnosis of celiac disease.
It is important to highlight that being overweight may prevent doctors from testing patients for
celiac disease due to bias, which is particularly relevant in minority populations.
- Additionally, the discussion should stress the complications of celiac disease that may arise
after the initiation of a gluten-free diet. While the authors mention fatty liver and metabolic
disease, it would be beneficial to include more recent findings, such as those from Aggarwal et
al. in "Digestive Diseases and Sciences" (doi: 10.1007/s10620-024-08426-5).
References:
- There is an error in the references where the same study is cited twice (numbers 26 and 54).
This should be corrected to ensure accuracy and avoid redundancy.
Overall comments:
While the manuscript offers valuable insights into the relationship between celiac disease and
obesity, addressing these concerns will enhance its clarity, accuracy, and overall impact. One
key issue is the need for more clarity on the population included in the meta-analysis, specifically
whether the data pertains to individuals before or after their diagnosis of celiac disease and
distinguishing between adults and children. Additionally, a key issue is that a recent meta-
analysis on this topic was published (Barone et al., Nutr Rev. 2023 Feb 10;81(3):252-266. doi:
10.1093/nutrit/nuac052). The authors need to clearly differentiate their work from this existing
publication and highlight what new insights or data their study brings to the field. This is very
much needed before recommending publication. I encourage the authors to revise the manuscript
accordingly and appreciate their contributions to this important field of study.