Ricerc@Sapienza

Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a bone loss index in postmenopausal women and as a marker of
inflammation in coeliac patients. The aims of this work were to evaluate the effect of gluten-free diet (GFD) on NLR
retrospectively and study the relationship between NLR and Mediterranean diet adherence and selected food groups (fruits,
vegetables, red meat, potatoes, and unrefined and refined cereals). Adult individuals (n = 50), who had been on a strict GFD by
at least 6 months, were recruited. The degree of adherence to the Mediterranean diet was calculated with two different scores:
the Mediterranean Diet Score (MDS-14), assessed through the validated 14-item questionnaire of the PREDIMED study, and
the MEDScore (Score-55) proposed by Panagiotakos. The latter includes the consumption of unrefined cereals (UC). High
percentages of osteopenia and osteoporosis were found within the recruited subjects, who furnished the reports of bone mineral
density (BMD), in particular in postmenopausal (Post-M) women. Recent NLR was higher in subjects with osteoporosis
compared to osteopenia and normal BMD. However, retrospective analysis showed both increase and decrease in NLR after
GFD, with no significant differences between Marsh grade, anemia, and BMD status. Moreover, premenopausal previous
pregnancy (Pre-MPP) and Post-M had higher NLR at diagnosis compared to Men and premenopausal (Pre-M), but higher
differences were observed in recent NLR between Pre-MPP and Men only. Chocolate consumption was associated with lower
recent NLR, whereas the latter was correlated with Score-55, but not with MDS-14. Moreover, refined cereal consumption was
correlated with recent NLR. Although large prospective studies are needed in order to clarify the relationship between UC and
NLR in coeliac patients, in this pilot study, we have investigated for the first time the relationship between NLR, dietary habit,
and osteoporosis in coeliac disease.