Investigators from multiple institutions conducted a case-control study to assess growth in children with celiac disease (CD). Children were eligible if they were a newborn and had a first-degree relative with CD. Participants had their length and height measured about once a month from birth to age 6 years. Participants also periodically were monitored for serum markers of CD, including serum antigliadin and anti-transglutaminase-IgA antibodies. Participants who were diagnosed during the study period with CD per European Society for Paediatric Gastroenterology, Hepatology, and Nutrition criteria were considered cases; those who were not were considered controls.
The primary outcomes were length and height, standardized for age and sex by transforming to z-scores based on the WHO growth standards. Investigators characterized cases and controls using descriptive statistics. They also compared outcomes between case and control participants at birth, 1, 4, 12, and 24 months of age using t-tests, as well as over the first year of life and from birth to age 6 years using linear mixed-effect models.
There were 944 participants included in analysis, 113 (11.9%) of whom developed CD by age 6 years. The median age at CD diagnosis was 40 months. None of the cases developed CD before 12 months of age.
In comparison of outcomes at birth, 1, 4, 12, and 24 months, cases had significantly lower length and weight mean z-scores than controls at 12 and 24 months of age but no significant difference in length and weight z-scores prior to 12 months of age. In linear models, however, cases had a significantly lower growth rate in weight (−0.027 z-score/month; 95% CI, −0.038, −0.017) and length (−0.018 z-score/month; 95% CI, −0.031, −0.005) during the first year of life. The growth of cases from birth to age 6 years also was significantly different from controls (weight, −0.006 z-score/month; 95% CI, −0.009, −0.004; length, −0.007 z-score/month; 95% CI, −0.010, −0.005).
Investigators conclude that growth was significantly slower in children with CD, and this slow growth was apparent before CD diagnosis.
Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The results of the current study suggest that growth is affected long before symptoms and diagnosis are apparent in CD. CD has been increasingly diagnosed in the past few years.1 (See AAP Grand Rounds. 2018;39;9.2 ) The cause of this increase has not been elucidated. In the current study, investigators found that altered growth may already be manifested before any clinical or serologic signs are evident. Already at 4 months, before gluten introduction, infants who eventually will develop CD were about 0.5 cm shorter and 100 g lighter than their peers who did not develop CD by...