search
Back to results

Cardiovascular Risk Factors in Coeliac Disease: a Series of Studies (ARCTIC)

Primary Purpose

Coeliac Disease

Status
Recruiting
Phase
Not Applicable
Locations
Hungary
Study Type
Interventional
Intervention
Dietary intervention
Standard of care
Cardiovascular risk-related parameters
Sponsored by
University of Pecs
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Coeliac Disease focused on measuring coeliac disease, cardiovascular risk, body composition, dietary intervention

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria (applies to all subjects):

  • Age should be over 18 years.
  • Blood collection must be indicated with medical conditions.
  • Signed informed consent.

Inclusion Criteria (applies to specific cohorts of patients):

  • The diagnosis of CD should be set up according to the current guidelines (based on serology and histology in adults or as per the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline in children).
  • The newly diagnosed CD patients should be on a gluten-containing diet.
  • Patients following a GFD for at least 1 year should exhibit good dietary adherence.
  • In the randomized controlled trial, strict dietary adherence will be established based on CD-specific serology (normal level of antibodies), urine gluten immunogenic peptides (negative urine test), and dietary interview (convincing knowledge on the GFD and positive attitude towards strict adherence).
  • Control subjects should be free from CD according to the recent guidelines and should be on a gluten-containing diet.

Exclusion Criteria:

  • Chronic conditions:

    • Estimated glomerular filtration rate calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula is <60mL/min/1.73m2 (CKD3 or more severe kidney failure).
    • Liver cirrhosis in Child-Pugh B-C.
    • Heart failure (New York Heart Association (NYHA) III-IV).
    • Active malignant diseases.
  • Any acute diseases or acute deterioration of underlying chronic conditions.
  • Diseases that may be associated with clinically relevant malabsorption.
  • Refractory CD.
  • Pregnancy, lactation.
  • Patients unable to understand the essentials of the informed consent.
  • Lack of consent or withdrawal of consent.

Sites / Locations

  • First Department of Medicine, Medical School, University of PécsRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Dietary intervention

Standard of care

Arm Description

Patients randomized to the dietary intervention group.

Patients randomized to the standard of care group.

Outcomes

Primary Outcome Measures

Body height
Height in centimeters measured by a stadiometer.
Body weight
Weight in kilograms measured by an InBody 770 body composition analyzer.
Body mass index (BMI)
BMI in kg/m2 calculated by an InBody 770 body composition analyzer.
Body fat mass
Body fat mass in kilograms measured by an InBody 770 body composition analyzer.
Percent body fat
Percent body fat in percentage measured by an InBody 770 body composition analyzer.
Skeletal muscle mass
Skeletal muscle mass in kilograms measured by an InBody 770 body composition analyzer.
Visceral fat area
Visceral fat area in cm2 measured by an InBody 770 body composition analyzer.
Total body water
Total body water in liters measured by an InBody 770 body composition analyzer.

Secondary Outcome Measures

Waist circumference
CV risk assessment will be performed by measuring waist circumference in centimeters.
Blood pressure
CV risk assessment will be performed by measuring blood pressure in Hgmm.
Fatty liver disease
Transabdominal ultrasonography will be used to assess the extent of fatty liver disease (based on non-alcoholic fatty liver disease-liver fat score (NAFLD-LFS), with a score range of 0-3).
Cardiovascular risk assessment
CV risk assessment will be performed by the Systematic Coronary Risk Evaluation (SCORE) chart.
Coeliac disease-related symptoms
CD-related symptoms will be assessed by the Celiac Symptom Index (CSI).
Coeliac disease-specific quality of life
CD-specific quality of life questionnaire will be also used (Celiac Disease Quality of Life (CD-QoL).
Disease activity
Disease activity will be estimated by tissue transglutaminase (tTG) levels.
Sarcopenia
Sarcopenia will be assessed based on body composition and handgrip strength via handgrip dynamometer.
Triglyceride level
Triglyceride level in mmol/L.
Cholesterol level
Cholesterol (total, HDL and LDL lipoproteins) level in mmol/L.
Fasting glucose level
Fasting glucose level in mmol/L.
Fasting insulin level
Fasting insulin level in mmol/L.
Haemoglobin (Hb) A1c level
HbA1c level in percentage.
Homeostasis Model Assessment (HOMA) index
HOMA index
Bilirubin level
Bilirubin level in µmol/L.
Uric acid level
Uric acid µmol/L.
Urea level
Urea level in mmol/L.
Creatinine level
Creatinine level in µmol/L.
Sodium level
Sodium level in mmol/L.
Potassium level
Potassium level in mmol/L.
Calcium level
Calcium level in mmol/L.
Vitamin D
Vitamin D level in ng/mL.
Vitamin B12
Vitamin B12 level in pg/mL.
Folic acid level
Folic acid level in µg/L.
Iron level
Iron level in µmol/L.
Ferritin level
Ferritin level in µg/L.
Transferrin level
Transferrin level in g/L.
Transferrin saturation
Transferrin saturation in percentage.
International Normalized Ratio (INR)
INR
Aspartate aminotransferase level
Aspartate aminotransferase level in U/L.
Alanine aminotransferase level
Alanine aminotransferase in U/L.
Fibrosis-4 (FIB-4) Index
FIB-4 Index for liver fibrosis.
Total protein level
Total protein level in g/L.
Albumin level
Albumin level in g/L.
Immunoglobulins
Immunoglobulins in U/mL.
High-sensitivity C-reactive protein (hs-CRP) level
hs-CRP level in mg/L.
Fibrinogen level
Fibrinogen level in g/L.
Blood counts
Blood counts in Giga/L.
Homocysteine levels
Homocysteine levels in µmol/L.
Interleukin-6 levels
Interleukin-6 levels in ng/L.
Leptin levels
Leptin levels in ng/mL.
Ghrelin levels
Ghrelin levels in pg/mL.
Adiponectin levels
Adiponectin levels in µg/mL.
Galectin-3 levels
Galectin-3 levels in ng/mL.
Dietary interview
Dietary adherence will be determined by dietary interview provided by an expertise dietitian.
Celiac Disease Adherence Test
Dietary adherence will be determined by the Celiac Disease Adherence Test (CDAT).
Coeliac-specific antibodies
Dietary adherence will be determined by coeliac-specific antibodies (tissue transglutaminase (tTG) immunoglobulin (Ig) A/IgG and endomysium antibody levels (EMA) IgA) in U/mL.
Urine gluten immunogenic peptide
Dietary adherence will be determined by urine gluten immunogenic peptide (GIP) measurement.
Diet composition
The composition of a GFD will be evaluated with the indicator of adherence to the Mediterranean diet, the Mediterranean Diet Score (MDS).

Full Information

First Posted
August 3, 2022
Last Updated
April 18, 2023
Sponsor
University of Pecs
search

1. Study Identification

Unique Protocol Identification Number
NCT05530070
Brief Title
Cardiovascular Risk Factors in Coeliac Disease: a Series of Studies
Acronym
ARCTIC
Official Title
Cardiovascular Risk Factors in Coeliac Disease: a Series of Studies
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 12, 2022 (Actual)
Primary Completion Date
September 2026 (Anticipated)
Study Completion Date
December 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Pecs

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This investigation examines the most important cardiovascular risk factors (e.g., metabolic parameters, body composition) and their changes in coeliac disease. The series of studies allow to assess body composition and cardiovascular risk-related metabolic parameters of newly diagnosed and treated coeliac patients in their complexity and to test if they change during therapy. The interventional part of the investigation aims to answer the question if a dietary intervention mitigates the unfavorable effects of unbalanced diet.
Detailed Description
The global prevalence of coeliac disease (CD) is increasing, which contributes to the disease's significant public health care burden. Body composition and metabolic parameters of coeliac patients differ from the healthy population. Patients with non-classical CD are not necessarily lean; they usually have normal body weight but can be even overweight or obese. In coeliac patients, bodyweight tends to elevate, whereas the body composition changes unfavourably during a gluten-free diet (GFD). A reason for gaining weight is the improvement of malabsorption but an important contributor is the nutrient composition of the GFD, which generally has a high calorie density with high carbohydrate and fat content while being low in fibre. While terminating or mitigating the inflammatory process - if done without adequate dietary control - a GFD can readily lead to weight gain and unfavourably metabolic consequences (e.g., dyslipidemia, fatty liver disease, insulin resistance). The result can be an increase in cardiovascular risk in CD patients with a normal or high body weight at diagnosis. However, limited information is available on the cardiovascular (CV) risk in coeliac disease, and the data are controversial. This study examines the body composition and cardiovascular risk-related metabolic parameters at the diagnosis and on a gluten-free diet in a Hungarian cohort of CD patients. The randomised controlled trial (RCT) investigates the effect of structured, repeated, group-based dietary education on the examined metabolic parameters and body composition. This study aims to draw attention to a new aspect of the management of CD patients: from a metabolic and cardiovascular point of view. Findings will help to identify which parameters are beneficial to optimize and re-assess during follow-up in CD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coeliac Disease
Keywords
coeliac disease, cardiovascular risk, body composition, dietary intervention

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
This trial is a series of three multicentric studies. It includes 1) a case-control study, which compares newly diagnosed CD patients (n=37) and CD patients on a GFD (n=99) to matched non-coeliac control subjects (n=136); 2) a prospective cohort study, which investigates how the outcomes change during a 1-year GFD started after diagnosis of CD (n=236); 3) an RCT, which investigates how a dietetic intervention (n=95) influences the outcomes, compared to standard of care (n=95), in CD patients following a strict GFD for at least 1 year. There will be no intervention for the sake of the study in the case-control and the cohort study. Parameters of interest will be assessed only once in the case-control study and twice in the cohort study. In the RCT, randomization will be carried out after the baseline dietary education and interview, in 1:1 allocation ratio. Parameters will be recorded at baseline and the end of the study.
Masking
Care ProviderOutcomes Assessor
Masking Description
Due to the nature of the study, the blinding of the participants is not possible, however bias is unlikely due to objective data collection. The blinding of the physicians, data managers and statisticians will be secured.
Allocation
Randomized
Enrollment
190 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dietary intervention
Arm Type
Active Comparator
Arm Description
Patients randomized to the dietary intervention group.
Arm Title
Standard of care
Arm Type
Active Comparator
Arm Description
Patients randomized to the standard of care group.
Intervention Type
Other
Intervention Name(s)
Dietary intervention
Intervention Description
Patients will participate in a structured, group-based dietary counseling, which is planned to take place every two months for 1 year. We will also use info-communication tools (online) depending on the epidemiological situation. The aim of the counseling is to maintain a GFD and to develop a healthy lifestyle, in line with the Mediterranean diet.
Intervention Type
Other
Intervention Name(s)
Standard of care
Intervention Description
Patients will receive standard of care and baseline dietary education.
Intervention Type
Diagnostic Test
Intervention Name(s)
Cardiovascular risk-related parameters
Intervention Description
Anthropometric measurements (body height, body composition assessment-InBody 770), questionnaires (symptoms, quality of life, dietary adherence, diet quality, cardiovascular risk), assessment of sarcopenia (handgrip dynamometer), urine collection (dietary adherence - urine gluten immunogenic peptide detection), blood collection (immunological tests, hormone levels complemented with routine laboratory panel), transabdominal US examination to assess the extent of fatty liver disease.
Primary Outcome Measure Information:
Title
Body height
Description
Height in centimeters measured by a stadiometer.
Time Frame
4 years
Title
Body weight
Description
Weight in kilograms measured by an InBody 770 body composition analyzer.
Time Frame
4 years
Title
Body mass index (BMI)
Description
BMI in kg/m2 calculated by an InBody 770 body composition analyzer.
Time Frame
4 years
Title
Body fat mass
Description
Body fat mass in kilograms measured by an InBody 770 body composition analyzer.
Time Frame
4 years
Title
Percent body fat
Description
Percent body fat in percentage measured by an InBody 770 body composition analyzer.
Time Frame
4 years
Title
Skeletal muscle mass
Description
Skeletal muscle mass in kilograms measured by an InBody 770 body composition analyzer.
Time Frame
4 years
Title
Visceral fat area
Description
Visceral fat area in cm2 measured by an InBody 770 body composition analyzer.
Time Frame
4 years
Title
Total body water
Description
Total body water in liters measured by an InBody 770 body composition analyzer.
Time Frame
4 years
Secondary Outcome Measure Information:
Title
Waist circumference
Description
CV risk assessment will be performed by measuring waist circumference in centimeters.
Time Frame
4 years
Title
Blood pressure
Description
CV risk assessment will be performed by measuring blood pressure in Hgmm.
Time Frame
4 years
Title
Fatty liver disease
Description
Transabdominal ultrasonography will be used to assess the extent of fatty liver disease (based on non-alcoholic fatty liver disease-liver fat score (NAFLD-LFS), with a score range of 0-3).
Time Frame
4 years
Title
Cardiovascular risk assessment
Description
CV risk assessment will be performed by the Systematic Coronary Risk Evaluation (SCORE) chart.
Time Frame
4 years
Title
Coeliac disease-related symptoms
Description
CD-related symptoms will be assessed by the Celiac Symptom Index (CSI).
Time Frame
4 years
Title
Coeliac disease-specific quality of life
Description
CD-specific quality of life questionnaire will be also used (Celiac Disease Quality of Life (CD-QoL).
Time Frame
4 years
Title
Disease activity
Description
Disease activity will be estimated by tissue transglutaminase (tTG) levels.
Time Frame
4 years
Title
Sarcopenia
Description
Sarcopenia will be assessed based on body composition and handgrip strength via handgrip dynamometer.
Time Frame
4 years
Title
Triglyceride level
Description
Triglyceride level in mmol/L.
Time Frame
4 years
Title
Cholesterol level
Description
Cholesterol (total, HDL and LDL lipoproteins) level in mmol/L.
Time Frame
4 years
Title
Fasting glucose level
Description
Fasting glucose level in mmol/L.
Time Frame
4 years
Title
Fasting insulin level
Description
Fasting insulin level in mmol/L.
Time Frame
4 years
Title
Haemoglobin (Hb) A1c level
Description
HbA1c level in percentage.
Time Frame
4 years
Title
Homeostasis Model Assessment (HOMA) index
Description
HOMA index
Time Frame
4 years
Title
Bilirubin level
Description
Bilirubin level in µmol/L.
Time Frame
4 years
Title
Uric acid level
Description
Uric acid µmol/L.
Time Frame
4 years
Title
Urea level
Description
Urea level in mmol/L.
Time Frame
4 years
Title
Creatinine level
Description
Creatinine level in µmol/L.
Time Frame
4 years
Title
Sodium level
Description
Sodium level in mmol/L.
Time Frame
4 years
Title
Potassium level
Description
Potassium level in mmol/L.
Time Frame
4 years
Title
Calcium level
Description
Calcium level in mmol/L.
Time Frame
4 years
Title
Vitamin D
Description
Vitamin D level in ng/mL.
Time Frame
4 years
Title
Vitamin B12
Description
Vitamin B12 level in pg/mL.
Time Frame
4 years
Title
Folic acid level
Description
Folic acid level in µg/L.
Time Frame
4 years
Title
Iron level
Description
Iron level in µmol/L.
Time Frame
4 years
Title
Ferritin level
Description
Ferritin level in µg/L.
Time Frame
4 years
Title
Transferrin level
Description
Transferrin level in g/L.
Time Frame
4 years
Title
Transferrin saturation
Description
Transferrin saturation in percentage.
Time Frame
4 years
Title
International Normalized Ratio (INR)
Description
INR
Time Frame
4 years
Title
Aspartate aminotransferase level
Description
Aspartate aminotransferase level in U/L.
Time Frame
4 years
Title
Alanine aminotransferase level
Description
Alanine aminotransferase in U/L.
Time Frame
4 years
Title
Fibrosis-4 (FIB-4) Index
Description
FIB-4 Index for liver fibrosis.
Time Frame
4 years
Title
Total protein level
Description
Total protein level in g/L.
Time Frame
4 years
Title
Albumin level
Description
Albumin level in g/L.
Time Frame
4 years
Title
Immunoglobulins
Description
Immunoglobulins in U/mL.
Time Frame
4 years
Title
High-sensitivity C-reactive protein (hs-CRP) level
Description
hs-CRP level in mg/L.
Time Frame
4 years
Title
Fibrinogen level
Description
Fibrinogen level in g/L.
Time Frame
4 years
Title
Blood counts
Description
Blood counts in Giga/L.
Time Frame
4 years
Title
Homocysteine levels
Description
Homocysteine levels in µmol/L.
Time Frame
4 years
Title
Interleukin-6 levels
Description
Interleukin-6 levels in ng/L.
Time Frame
4 years
Title
Leptin levels
Description
Leptin levels in ng/mL.
Time Frame
4 years
Title
Ghrelin levels
Description
Ghrelin levels in pg/mL.
Time Frame
4 years
Title
Adiponectin levels
Description
Adiponectin levels in µg/mL.
Time Frame
4 years
Title
Galectin-3 levels
Description
Galectin-3 levels in ng/mL.
Time Frame
4 years
Title
Dietary interview
Description
Dietary adherence will be determined by dietary interview provided by an expertise dietitian.
Time Frame
4 years
Title
Celiac Disease Adherence Test
Description
Dietary adherence will be determined by the Celiac Disease Adherence Test (CDAT).
Time Frame
4 years
Title
Coeliac-specific antibodies
Description
Dietary adherence will be determined by coeliac-specific antibodies (tissue transglutaminase (tTG) immunoglobulin (Ig) A/IgG and endomysium antibody levels (EMA) IgA) in U/mL.
Time Frame
4 years
Title
Urine gluten immunogenic peptide
Description
Dietary adherence will be determined by urine gluten immunogenic peptide (GIP) measurement.
Time Frame
4 years
Title
Diet composition
Description
The composition of a GFD will be evaluated with the indicator of adherence to the Mediterranean diet, the Mediterranean Diet Score (MDS).
Time Frame
4 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria (applies to all subjects): Age should be over 18 years. Blood collection must be indicated with medical conditions. Signed informed consent. Inclusion Criteria (applies to specific cohorts of patients): The diagnosis of CD should be set up according to the current guidelines (based on serology and histology in adults or as per the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline in children). The newly diagnosed CD patients should be on a gluten-containing diet. Patients following a GFD for at least 1 year should exhibit good dietary adherence. In the randomized controlled trial, strict dietary adherence will be established based on CD-specific serology (normal level of antibodies), urine gluten immunogenic peptides (negative urine test), and dietary interview (convincing knowledge on the GFD and positive attitude towards strict adherence). Control subjects should be free from CD according to the recent guidelines and should be on a gluten-containing diet. Exclusion Criteria: Chronic conditions: Estimated glomerular filtration rate calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula is <60mL/min/1.73m2 (CKD3 or more severe kidney failure). Liver cirrhosis in Child-Pugh B-C. Heart failure (New York Heart Association (NYHA) III-IV). Active malignant diseases. Any acute diseases or acute deterioration of underlying chronic conditions. Diseases that may be associated with clinically relevant malabsorption. Refractory CD. Pregnancy, lactation. Patients unable to understand the essentials of the informed consent. Lack of consent or withdrawal of consent.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Judit Bajor, MD, PhD
Phone
+36 72 536 000
Email
bajor.judit@pte.hu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Judit Bajor, MD, PhD
Organizational Affiliation
Division of Gastroenterology, First Department of Medicine, University of Pécs, 7624 Pécs, Hungary
Official's Role
Principal Investigator
Facility Information:
Facility Name
First Department of Medicine, Medical School, University of Pécs
City
Pécs
State/Province
Baranya
ZIP/Postal Code
7624
Country
Hungary
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Judit Bajor, MD, PhD
Phone
+36 72 536 000
Email
bajor.judit@pte.hu

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
10871564
Citation
Capristo E, Addolorato G, Mingrone G, De Gaetano A, Greco AV, Tataranni PA, Gasbarrini G. Changes in body composition, substrate oxidation, and resting metabolic rate in adult celiac disease patients after a 1-y gluten-free diet treatment. Am J Clin Nutr. 2000 Jul;72(1):76-81. doi: 10.1093/ajcn/72.1.76.
Results Reference
background
PubMed Identifier
26212198
Citation
Newnham ED, Shepherd SJ, Strauss BJ, Hosking P, Gibson PR. Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5-year longitudinal study from diagnosis. J Gastroenterol Hepatol. 2016 Feb;31(2):342-9. doi: 10.1111/jgh.13060.
Results Reference
background
PubMed Identifier
28067892
Citation
Nunes-Silva JG, Nunes VS, Schwartz RP, Mlss Trecco S, Evazian D, Correa-Giannella ML, Nery M, Queiroz MS. Impact of type 1 diabetes mellitus and celiac disease on nutrition and quality of life. Nutr Diabetes. 2017 Jan 9;7(1):e239. doi: 10.1038/nutd.2016.43.
Results Reference
background
PubMed Identifier
31935859
Citation
Villanueva M, Oyarzun A, Leyton B, Gonzalez M, Navarro E, Canales P, Ossa C, Munoz MP, Bascunan KA, Araya M. Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades. Nutrients. 2020 Jan 6;12(1):156. doi: 10.3390/nu12010156.
Results Reference
background
PubMed Identifier
30650530
Citation
Melini V, Melini F. Gluten-Free Diet: Gaps and Needs for a Healthier Diet. Nutrients. 2019 Jan 15;11(1):170. doi: 10.3390/nu11010170.
Results Reference
background
PubMed Identifier
31583132
Citation
Costa A, Brito GAP. Anthropometric Parameters in Celiac Disease: A Review on the Different Evaluation Methods and Disease Effects. J Nutr Metab. 2019 Sep 9;2019:4586963. doi: 10.1155/2019/4586963. eCollection 2019.
Results Reference
background
PubMed Identifier
22457854
Citation
Tucker E, Rostami K, Prabhakaran S, Al Dulaimi D. Patients with coeliac disease are increasingly overweight or obese on presentation. J Gastrointestin Liver Dis. 2012 Mar;21(1):11-5.
Results Reference
background
PubMed Identifier
32790023
Citation
Suarez-Gonzalez M, Bousono Garcia C, Jimenez Trevino S, Iglesias Cabo T, Diaz Martin JJ. Influence of nutrition education in paediatric coeliac disease: impact of the role of the registered dietitian: a prospective, single-arm intervention study. J Hum Nutr Diet. 2020 Dec;33(6):775-785. doi: 10.1111/jhn.12800. Epub 2020 Aug 12.
Results Reference
background
PubMed Identifier
33669442
Citation
Marciniak M, Szymczak-Tomczak A, Mahadea D, Eder P, Dobrowolska A, Krela-Kazmierczak I. Multidimensional Disadvantages of a Gluten-Free Diet in Celiac Disease: A Narrative Review. Nutrients. 2021 Feb 16;13(2):643. doi: 10.3390/nu13020643.
Results Reference
background

Learn more about this trial

Cardiovascular Risk Factors in Coeliac Disease: a Series of Studies

We'll reach out to this number within 24 hrs