Effects of age of diagnosis and dietary compliance on growth parameters of patients with celiac disease

Comba, Atakan; Çaltepe, Gönül; Yüce, Özlem; Erena, Esra; Kalaycı, Ayhan Gazi

doi:10.5546/aap.2018.eng.248

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…For this reason, the growth trajectory must be used as a marker throughout the diagnostic process for CD [ 60 , 61 , 62 , 63 , 64 , 65 ]. Our results agree with the study by Comba et al [ 66 ] on the level of development at the time of diagnosis in a sample of 73 paediatric CD patients, 35 (47.9%) of whom were short for their age.…”

Section: Discussionsupporting

confidence: 93%

More Than Three Years for Normalisation of Routine Laboratory Values after Gluten Withdrawal in Paediatric Coeliac Patients

Ventura,

Rodriguez,

Suescum

et al. 2023

Children

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The assessment of the nutritional and inflammatory status of paediatric patients with coeliac disease is an interesting approach to early diagnosis and functional follow-up. Most authors agree that the normalisation of symptoms takes about one year. The aim of the study was to evaluate the clinical manifestation and normalisation of routine analytics in Spanish children diagnosed with celiac disease. Methods: We performed a retrospective case–control study in Spanish paediatric patients, including 21 celiac patients and 20 healthy controls. The 21 patients selected in the case–control study were followed for 5 years after starting a gluten-free diet (GFD). All patients had type 3 villous atrophy according to the Marsh–Oberhuber classification. A total of 39 blood samples were taken before the start of the GFD, and 109 were taken after. Twenty control sera from healthy donors were used for comparison. Results: We found that patients had a subclinical but statistically significant increase in blood calcium, transaminases, and white blood cells, and a decrease in serum iron, at the time of diagnosis. Our study also shows that analytical values normalise within five years on a gluten-free diet. Conclusions: The use of a combination of subclinical changes, including low iron, high calcium, elevated leukocytes, lymphocytes, and ALT levels in blood samples, together with a low growth percentile, is pertinent in detecting coeliac disease. This set of parameters could help in the diagnosis of patients without clinical symptoms. We can also show that the levels of Fe, Ca, transaminases, and leucocytes remain subclinically altered after 3 years, despite the gluten-free diet.

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Section: Discussionsupporting

confidence: 93%

More Than Three Years for Normalisation of Routine Laboratory Values after Gluten Withdrawal in Paediatric Coeliac Patients

Ventura,

Rodriguez,

Suescum

et al. 2023

Children

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“…An early diagnosis and proper dietary regimen continuation minimize the risk of a compromised final height. Accordingly, Comba et al (33) observed that patients who received the diagnosis of CD after the age of 6 had a significantly lower z-score for BMI, height and weight, as compared to children diagnosed at a younger age, indicating that when CD diagnosis is posed after puberty, the chances for growth catch-up are lower.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms

et al. 2019

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Celiac disease (CD) is a systemic autoimmune disease due to a dysregulated mucosal immune response to gluten and related prolamines in genetically predisposed individuals. It is a common disorder affecting ~1% of the general population, its incidence is steadily increasing. Changes in the clinical presentation have become evident since the 80s with the recognition of extra-intestinal symptoms like short stature, iron deficiency anemia, altered bone metabolism, elevation of liver enzymes, neurological problems. Recent studies have shown that the overall prevalence of extra-intestinal manifestations is similar between pediatric and adult population; however, the prevalence of specific manifestations and rate of improvement differ in the two age groups. For instance, clinical response in children occurs much faster than in adults. Moreover, an early diagnosis is decisive for a better prognosis. The pathogenesis of extra-intestinal manifestations has not been fully elucidated yet. Two main mechanisms have been advanced: the first related to the malabsorption consequent to mucosal damage, the latter associated with a sustained autoimmune response. Importantly, since extra-intestinal manifestations dominate the clinical presentation of over half of patients, a careful case-finding strategy, together with a more liberal use of serological tools, is crucial to improve the detection rate of CD.

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“…In our population, the mean diagnosis age was 6.1 years, which is between the age of the Marrakech series (5.8 years) [ 24 ], the Tunisian series (5.9 years) [ 36 ], the age in Mediterranean countries (5.9 years) [ 37 ], and between the mean diagnosis age of Turkish children (6.4 years) [ 38 ]. Nevertheless, our diagnosis age is high compared to that reported by Boudraa et al (3.6 years) [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Celiac Disease in Moroccan Children: Diagnostic Characteristics and Determinants of Diagnosis Delay

Mouslih,

El Rhazi,

Bahra

et al. 2023

Cureus

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Advances in the field of celiac disease have led to a better understanding of the disease, but it remains underdiagnosed and poses a daily challenge to clinicians to make a timely diagnosis. This study aims to analyze and describe diagnosis characteristics, diagnosis delay, and the factors influencing this delay in Moroccan children. Our study included 324 children diagnosed during the study period from January 01, 2010, to December 30, 2019, at the Department of Pediatrics, Hassan II University Hospital in Fez, Morocco. Data were collected using a collection grid and then analyzed using SPSS 26 software (IBM Corp., Armonk, NY). The results showed a female predominance (n=197, 60.8%), with a diagnosis age of 73.8±46.8 months. The mean age onset of symptoms was 51.3±41.2 months, and the diagnosis delay was 22.2±22.6 months, with only 32.7% (n=106) diagnosed less than 12 months after symptom onset. The most common consultation reason was diarrhea (n=149, 46%) and growth delay (n=105, 32.4%) and 50.5% (n=98) of parents consulted a pediatrician first. The three clinical, serologic, and histologic criteria made it possible to agree on the diagnosis, with the clinical profile dominated by the digestive form at 84.9% (n=279), serologic with the presence of IgA transglutaminase antibodies (95.7%; n=310), and histologic with villous atrophy at 91.7% (n=297). Unfortunately, 14.8% (n=48) of the children were diagnosed with a celiac crisis. The multivariate logistic regression analysis showed that as symptoms onset age increased, so did the risk of late diagnosis (OR=0.96, 95% CI: 0.94 to 0.97, p<0.001). Age of diagnosis was also associated with delayed diagnosis (OR=19.68, 95% CI: 8.77 to 44.15, p<0.001). The combination of these variables and the diagnosis delay argues in favor of adopting a diagnosis strategy that includes raising awareness among healthcare professionals of the need to identify typical and atypical cases early in order to reduce the adverse effects of late diagnosis and the complications that can result. This methodology for improving diagnoses may also unearth previously unknown aspects of celiac disease in Moroccan children.

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Effects of age of diagnosis and dietary compliance on growth parameters of patients with celiac disease

Abstract: Delay in CD diagnosis negatively affected both the height and weight and other growth parameters. GFD compliance positively affected the patients' all growth parameters, especially weight and BMI z-score.

Cited by 8 publications

References 24 publications

More Than Three Years for Normalisation of Routine Laboratory Values after Gluten Withdrawal in Paediatric Coeliac Patients

More Than Three Years for Normalisation of Routine Laboratory Values after Gluten Withdrawal in Paediatric Coeliac Patients

Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms

Celiac Disease in Moroccan Children: Diagnostic Characteristics and Determinants of Diagnosis Delay

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