The Gluten Free Diet's Impact on Growth in Children with Celiac Disease in Two Different Countries.

Naire Sansotta,Karine Amirikian,Hilary Jericho,Silvia Barzaghi,Stefano Guandalini,Marco Cipolli,Gloria Tridello,Simone Romano

doi:10.3390/nu12061547

Abstract

The effects of gluten free diet (GFD) on body mass index (BMI) and growth parameters in pediatric patients with celiac disease (CD) and their dependence on different socio-cultural environments are poorly known. We conducted an international retrospective study on celiac patients diagnosed at the University of Verona, Italy, and at the University of Chicago, Chicago, IL, USA, as underweight. A total of 140 celiac children and 140 controls (mean age 8.4 years) were enrolled in Chicago; 125 celiac children and 125 controls (mean age 7.3 years, NS) in Verona. At time of diagnosis, Italian celiac children had a weight slightly lower (p = 0.060) and a BMI z-score significantly (p < 0.001) lower than their American counterparts. On GFD, Italian celiac children showed an increased prevalence of both underweight (19%) as well as overweight (9%), while American children showed a decrease prevalence of overweight/obese. We concluded that while the GFD had a similar impact on growth of celiac children in both countries, the BMI z-score rose more in American than in Italian celiac children. Additionally, in Italy, there was an alarming increase in the proportion of celiac children becoming underweight. We speculate that lifestyle and cultural differences may explain the observed variations.

Highlights

Celiac disease (CD), is a lifelong condition that affects the small intestine in genetically susceptible individuals [1]
We hypothesized that the greater availability of industrialized gluten free products in the US would lead to a higher increase of body mass index (BMI) in the American celiac children than in the Italian ones
We found that while only 4% of US celiacs were underweight on the gluten free diet (GFD), 19% of celiac disease (CD) children in Italy were underweight on the GFD

Summary

Introduction

Celiac disease (CD), is a lifelong condition that affects the small intestine in genetically susceptible individuals [1]. The symptoms attributable to the disease are highly variable and are influenced by age [2]. Growth failure in terms of length (or height) or weight may be the earliest sign of the disease reported in 14% of children at diagnosis [3,4]. Between 11% and 13% of patients have been noted to be overweight or even obese at presentation [5,6]. The only effective treatment for CD is a strict, lifelong adherence to a GFD. This typically results in resolution of small intestinal inflammation and associated symptoms [7]

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Discussion

Conclusion