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Low high-density lipoprotein-cholesterol (HDL-C) concentration correlates with increased cardiovascular risk. A great prevalence of celiac disease (CD) was reported among patients with low HDL-C concentration, and gluten-free diet (GFD) treatment seems to normalize lipid profile. We evaluated blood lipids and body composition in 26 CD patients with low HDL-C level (<1.0 mmol/L) at diagnosis and after GFD.A case-control study.The diagnosis was based on histologic evidence of subtotal or total duodenal villous atrophy. Patients were studied before and after GFD treatment (14.2±1.4 mo) with biopsy-proven return to normal of the duodenal mucosa. HDL-C was enzymatically assessed after precipitation of very low-density lipoprotein and low-density lipoprotein with heparin-magnesium. Apolipoprotein (Apo)-AI level was assessed by immunoturbidimetric assay; triglycerides by an enzymatic colorimetric method. Body composition was assessed by dual-energy x-ray absorptiometry.Body composition improved after GFD, with increasing body weight (P<0.05) essentially owing to increased fat mass (FM) (P<0.01), rather than fat-free mass (P=0.064). Total cholesterol and HDL-C were lower in untreated compared with treated patients (P<0.001 and P<0.0001). Apo-AI level increased significantly after GFD (1.20±0.22 vs. 1.46±0.17 g/L; P<0.0001). Apo-AI, sex, and FM were all significant determinants of HDL-C level; a positive correlation (R2=0.68; P<0.0001) was found between increase in HDL-C level and in FM after GFD treatment.Restoration of lipid profile in CD patients after GFD treatment may be explained by an increase in both Apo-AI secretion by intestinal cells and body fat stores.