Abstract
The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.
Highlights
The original descriptions characterized celiac disease (CD) as a condition that occurred especially during childhood, with severe diarrhea rapidly inducing malnutrition, but later, it was recognized as an autoimmune disorder, precipitated by exposure to dietary gluten in genetically predisposed people [1,2]
Since the early descriptions of CD in the 1950s [17,18] diagnosis of this disease is reached by means of small intestinal biopsies in the hospitals participating in this study, making it unlikely that an initial lack of awareness on the part of medical professionals in charge of the patients was a relevant factor influencing the number of patients diagnosed
Comparison of the chart exclusion rate in the three study periods (A, B and C) showed no significant changes. This suggests that the ~six-fold increase of patients diagnosed may represent a true increase of diagnosis of the CD. The fact that such increase coincides with the introduction of TTG and EMA determinations to the national public health systems suggests that their availability was a relevant factor to improve diagnosis
Summary
The original descriptions characterized celiac disease (CD) as a condition that occurred especially during childhood, with severe diarrhea rapidly inducing malnutrition, but later, it was recognized as an autoimmune disorder, precipitated by exposure to dietary gluten (a protein present in wheat, rye, barley and oats) in genetically predisposed people [1,2]. CD is known to have a broad clinical spectrum of presentations, large age range at which onset can occur and increased morbidity and mortality [2]. In the last few decades, there has been a steady global increase of obesity [3], and in recent years, celiac patients presenting with. As in many other countries, overweight/obesity has increased in Chile during the last decade [7], making our case interesting for assessing the relationship between CD and nutritional status. We set as objective to assess the clinical characteristics and nutritional status of celiac patients and their changes, if any, in the last
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