Celiac Disease Children Research Articles

Evaluating the Dietary Intakes of Energy, Macronutrients, Sugar, Fiber, and Micronutrients in Children With Celiac Disease.

Children with celiac disease (CD) follow a lifelong gluten-free diet. This restrictive diet may be associated with nutritional compromise. Our objectives were, therefore, to evaluate the dietary composition (energy, macronutrients and micronutrients, and fiber) in children with CD compared with healthy controls (HC) and relationship between dietary composition and socioeconomic status. This cross-sectional, case-control study recruited children with CD ages 2 to 18 years and HC matched for age, sex, and socioeconomic status. Clinical, sociodemographic, and dietary information were collected. A false discovery rate correction was applied to the P-value for multiple comparisons (q-value). Sixty-five CD children were matched with 65 HC (mean [SD] age: 10.2 [3.6] vs 10.1 [3.7] years, P = 0.96). Compared with HC, CD children had higher intakes of energy (2413.2 [489.9] vs 2190.8 (593.5) kcal/day, P = 0.02), total fat (818.1 ± 180.9 vs 714.3 ± 212.2 kcal/day, q = 0.018), and subtypes of fat (saturated, polyunsaturated, and monounsaturated). There were no differences in other macronutrients, sugar, micronutrients, or fiber between CD and HC, and no difference in dietary intake among CD between socioeconomic disadvantage versus advantage. Children with CD had lower weight z-scores (-0.06 [1.05] vs 0.47 [0.96], P = 0.003) and body mass index (BMI) z-scores (-0.02 [0.88] vs 0.41 [1.09], P = 0.02) than HC. Children with CD had higher calorie and fat intake compared with HC. Despite this, CD children had lower weight and BMI z-scores compared with HC.

Systematic Review With Meta‐analysis of the Health‐related Quality of Life in Children With Celiac Disease

The aim of this article is to systematically review and meta-analyze the published data on the comparison of the health-related quality of life (HRQOL) in children and adolescents with celiac disease (CD) and healthy children. Moreover, the meta-analysis was performed to compare the parent proxy-report and child self-report of HRQOL. The databases of PubMed, Embase, Scopus, and Cochrane library were searched from inception to April 2019 to identify observational studies that evaluated the HRQOL in children with CD. Studies comparing the HRQOL in celiac patients and healthy children, and also comparing the parent's proxy-report and child self-report of HRQOL were included. Comprehensive meta-analysis software was used for statistical analysis. Through our systematic search, 26 articles met our predefined inclusion criteria. The result of our meta-analysis on studies using the PedsQL questionnaire showed that the total score of HRQOL was not significantly different between celiac patients and healthy controls (SMD (95% confidence interval; CI]: -0.11[-0.45 to 0.23], P = 0.52). The result of our meta-analysis showed that the parents reported the child's diet and communication scores lower than that of children. Only 4 out of 11 studies showed a significant correlation between HRQOL and gluten-free diet (GFD) compliance and 2 of 4 studies showed a significant negative association between HRQOL and age at diagnosis. The results of the present study showed that there was no significant difference between children with CD and healthy controls regarding HRQOL. Moreover, the parental perception of their children's HRQOL was lower than the children's perception.

Chemiluminescent Immunoassay versus Enzyme Linked Immunosorbent Assays for IgA Anti-Tissue Transglutaminase Antibodies Assessment in Celiac Disease Children

Recent describing of atypical, silent and latent form of celiac disease (CD) increased the preocupation for screening methods.To perform a comparative study of immunoglobulin A (IgA) anti tissue-transglutaminase (tTG) antibodies (Ab) assessment using chemiluminescence versus Enzyme Linked Immunosorbent Assay (ELISA).The study included two lots.The first lot consisted in 35 biopsy confirmed CD children aged between two and 18 years.The control lot included 40 children with normal duodenal morphology on intestinal biopsy that underwent upper digestive endoscopy for different gastrointestinal symptoms.Serum samples were provided from all subjects for IgA measurement, IgA anti tTG and EMA assessment. Immulite 2500 Anti tTG IgA (Siemens Co, LA, USA) and ImmuLisa anti-hu tTG antibody IgA ELISA (Immco Diagnostics Inc, NY, USA) kits were used for tTG-Ab assessment. All children underwent HLA typing for DQ2/DQ8. The sensitivity for IgA tTG assessment was greater for chemiluminescence (93,3%) versus ELISA (86,6%), p[0,05, while specificity, positive and negative predictive value didn�t register significant differences. Statistical comparison of the two tested methods revealed a better sensitivity for chemiluminescence. Diagnosis algorithm optimisation may be obtained by associating IgA anti tTG-Ab assessment using chemiluminescence followed by EMA confirmation by indirect immunofluorescence for CD screening.

Fasting Neurotensin Levels in Pediatric Celiac Disease Compared with a Control Cohort.

Background and Aims Neurotensin (NT) is a gut hormone secreted by specific endocrine cells scattered throughout the epithelial layer of the small intestine, which has been identified as an important mediator in several gastrointestinal functions and disease conditions. Its potential involvement in celiac disease (CD) has been investigated, but there are conflicting findings. The aim of this study was to evaluate serum NT levels in children with CD at diagnosis, compared to a control group, and to investigate whether NT correlated in CD patients with symptoms, antibody response, and intestinal mucosal damage. Materials and Methods. Children (1-16 years old) undergoing gastrointestinal endoscopy for CD or for other clinical reasons were included in this study. Patients with CD diagnosed according to the 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines without biopsy were also recruited. Fasting serum samples were analyzed for NT levels using ELISA. Logistic regression, Wilcoxon rank sum, and Spearman's rank tests were used for statistical analysis. Results Thirty children (18 females, 2.2-15.9 years old) were enrolled. Of 25 patients who underwent endoscopy, 9 were CD patients, 13 were controls, and 3 were excluded due to nonspecific inflammation at duodenal biopsy. CD was diagnosed in 5 patients without biopsy. NT median was higher in CD patients compared to controls (13.25 (IQR 9.4-17.5) pg/ml vs. 7.8 (IQR 7.6-10) pg/ml; p = 0.02). No statistically significant association between NT and clinical, serological, or histological data of CD was observed in this CD cohort. Conclusions To our knowledge, this is the first study that evaluates NT in CD children from Italy. Results show that NT is higher in the serum of CD children at diagnosis compared to controls. However, larger-scale studies are required to validate these findings. Whether serum NT levels can be an adjunctive marker for pediatric CD remains currently elusive.

Neurological disorder in celiac patient after third molars extraction: is there a relation?

Celiac disease is an immune-mediated gluten-dependent systemic disorder characterized by a specific profile associated with small intestinal lesion. Some of the classical symptoms observed in patients with this condition are nutrient malabsorption, diarrhea, abdominal pain, fatigue and, more recently, neurological symptoms were associated with the disease. Therefore, the objective is to inform an unusual case of a patient with celiac disease that developed severe permanent paresthesia in the superior and inferior gingiva, tongue and palate after tooth extraction e to discuss the relation between both things.Descriptors: Nervous System Disease; Celiac Disease; Molar, Third.ReferencesFasano A, Catassi C. Clinical practice. Celiac disease. N Engl J Med 2012; 367(25):2419-26.Guandalini S, Assiri A. Celiac disease: a review. JAMA Pediatr. 2014;168(3):272-78.de Carvalho FK, de Queiroz AM, Bezerra da Silva RA, Sawamura R, Bachmann L, Bezerra da Silva LA et al. Oral aspects in celiac disease children: clinical and dental enamel chemical evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015,119(6):636-43.Sanders DS, Patel D, Stephenson TJ, Ward AM, McCloskey EV, Hadjivassiliou M et al. A primary care cross-sectional study of undiagnosed adult celiac disease. Eur J Gastroenterol Hepatol 2003;15(4):407-13.Briani C, Zara G, Alaedini A, Grassivaro F, Ruggero S, Toffanin E et al. Neurological complications of coeliac disease and autoimmune mechanisms: a prospective study. J Neuroimmunol 2008;195(1-2):171-75.Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001;59(9):1012-17.Green PH. The many faces of celiac disease: clinical presentation on celiac disease in the adult population. Gastroenterology. 2005;128(4Suppl1): S74-8.Muller AF, Donnelly MT, Smith CM, et al. Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol. 1996; 91(7):1430-35.Chin RL, Snader HW, Brannagan TH, Green PH, Hays AP, Alaedini A et al. Celiac neuropathy. Neurology. 2003;60(10):1581-85.Alaedini A, Green PH, Sander HW, Hays AP, Gamboa AT, Fasano A et al. Ganglioside reactive antibodies in the neuropathy associated with celiac disease. J Neuroimmunol. 2002; 127(1-2):145-48.Oh SJ, Melo AC, Lee DK, Cichy SW, Kim DS, Demerci M et al. Large fiber neuropathy in distal sensory neuropathy with normal routine nerve conduction. Neurology.2001;56(11):1570-72.

Evaluation of nasal mucociliary clearance time in children with celiac disease

ObjectivesCeliac disease is an autoimmune disorder that develops because of sensitivity to gluten-containing grains in genetically disposed individuals. Nasal mucociliary clearance is the most important protective factor that protects the upper and lower airways from foreign particulates. This study aimed to investigate the effect of celiac disease on nasal mucociliary clearance. MethodsThe study included patients with celiac disease and healthy children. Nasal mucociliary clearance time was measured using the saccharin test. The children's saccharin taste time was recorded in seconds. ResultsOverall, 65 children were included: 43 patients with celiac disease (66.2%) and 22 healthy children (33.8%). Of all the children, 42 (64.6%) were female, and the average age was 11.8 ± 4 years. Nasal mucociliary clearance time of patients with celiac disease (531 ± 155 s) was significantly prolonged in comparison to that of healthy children (448 ± 80 s) (p = 0.006). No relationships were found between the diagnosis age, celiac type, and histopathological phase and compliance with the gluten-free diet and nasal mucociliary clearance time of patients with celiac disease. ConclusionsThis study showed that nasal mucociliary clearance was prolonged in patients with celiac disease. A defect in nasal mucociliary clearance increases the risk of infection and inflammation in small airways. Studies reported a high prevalence of respiratory tract infection in patients with celiac disease, which was associated with malnutrition, vitamin deficiency, and hyposplenism. The findings of the present study indicated that impairment of nasal mucociliary clearance could play a role in the development of frequent lung infections in patients with celiac disease.

Nutritional Status, Dietary Intake, and Adherence to the Mediterranean Diet of Children with Celiac Disease on a Gluten-Free Diet: A Case-Control Prospective Study.

The only effective treatment for celiac disease (CD) is a life-long strict gluten-free diet (GFD). Nutritional adequacy of the GFD has remained controversial and a matter of debate for a long time. No large case-control studies on children regarding the nutritional adequacy of the GFD has been performed. In this study, children diagnosed with CD on a GFD for ≥ 2 years were recruited. Controls were age and gender-matched healthy children not affected with CD. In both groups, anthropometric measurements and energy expenditure information were collected. Dietary assessment was performed by a 3-day food diary. Adherence to the Mediterranean diet was estimated by the KIDMED index. Overall, 120 children with CD and 100 healthy children were enrolled. No differences were found between CD children and controls in anthropometric measurements and energy expenditure. In the CD group, the daily intake of fats was significantly higher while the consumption of fiber was lower in comparison with the control group. The median KIDMED index was 6.5 in CD children and 6.8 in healthy controls. The diet of children with CD in this study was nutritionally less balanced than controls, with a higher intake of fat and a lower intake of fiber, highlighting the need for dietary counseling.

Gluten Deprivation: What Nutritional Changes Are Found During the First Year in Newly Diagnosed Coeliac Children?

Aim: A gluten-free diet (GFD) can expose children to excessive calories and fat intake. The study is intended to verify whether and how food intake, laboratory parameters, and growth are modified by a year of GFD. Methods: In 79 CD (coeliac disease) children (mean age 7.9 ± 3.8 years, 52 females, 27 males) diagnosed over 24 months, 24-h food diaries, food-frequency patterns, anthropometric and laboratory parameters (mainly blood sugar, insulin, lipid profile, and homocysteine) were prospectively collected before and during the first year of GFD. Nutrient intakes were compared over time and with recommendations. They were also used as regressors to explain the levels and changes of metabolic and growth variables. p-values < 0.05 were considered statistically significant. Results: Average macronutrient intake did not change during the year. Caloric intake remained below 90% (p ≤ 0.0001) and protein intake above 200% (p ≤ 0.0001) of recommendations. Lipid intake was stable at 34% of overall energy intake. Unsaturated fats increased (less omega-6 and more omega-3 with a ratio improvement from 13.3 ± 5.5 to 8.8 ± 3.1) and so did fibers, while folate decreased. The children who experienced a containment in their caloric intake during the year, presented a slower catch-up growth. Some differences were found across gender and age groups. In particular, adolescents consumed less calories, and females more omega-3. Fiber and simple sugar intakes emerged as implicated in lipid profile shift: fibers negatively with triglycerides (TG) (p = 0.033), simple sugars negatively with high-density lipoprotein (HDL) (p = 0.056) and positively with TG (p = 0.004). Waist-to-height ratio was positively associated with homocysteine (p = 0.018) and Homeostasis Model Assessment (p = 0.001), negatively with fibers (p = 0.004). Conclusion: In the short run, GFD is nutritionally very similar to any diet with gluten, with some improvements in unsaturated fats and fiber intake. Along with simple sugars containment, this may offer CD patients the opportunity for a fresh start. Caloric intakes may shift and should be monitored, especially in adolescents.

HLA-DQ genotypes relative risks for celiac disease in Arabs: A case-control study.

It remains unknown what degree of risk is conferred by celiac disease (CD)-predisposing human leukocyte antigen (HLA)-DQ genotypes in Saudi Arabia compared with in Western countries. In this study, we aimed to determine the CD risk gradient associated with the HLA-DQ genotypes and to compare HLA-DQ genotypes between symptomatic patients with CD and screening-identified asymptomatic CD patients. We enrolled three groups of subjects, including 46 CD children diagnosed consecutively over the past 10 years, 54 CD children diagnosed during a mass screening of schoolchildren, and 192 healthy controls. All the participants were typed for the HLA-DQA1 and HLA-DQB1 genes by polymerase chain reaction sequence-specific oligonucleotide probes. Comparing the patients with CD to controls, we identified 5 groups in the CD risk gradient: (i) very high risk associated with the DQ2.5/DQ8 genotype (odds ratio [OR] 46.93); (ii) high risk (homozygous DQ2.5, DQ2.5/DQ2.2; OR 4.12-5.04); (iii) intermediate risk (heterozygous DQ2.5, DQ8/DQ2.2; OR 1.61 and 1.67); (iv) low risk (DQ8, DQ2.2); and (v) very low risk (DQ2.x, DQX.5, DQX.x). Heterozygous DQ8 was more common in screening-identified group compared to symptomatic patients (13.0% vs 2.2%); however, other genotypes were very similar between the two groups. The highest risk of developing CD in our Saudi Arabia population is associated with the DQ2.5/DQ8 genotype.

Diagnostic Delays in Children With Coeliac Disease in the Central European Region.

Coeliac disease (CD) is a systemic autoimmune disorder affecting about 1% of the population. Many patients remain undiagnosed or are diagnosed with substantial delay. We assessed diagnostic delays in symptomatic CD children in Central Europe (CE). Paediatric gastroenterologists in 5 CE countries retrospectively reported data of their patients diagnosed in 2016. Age at first CD-related symptom(s), first visit to paediatric gastroenterologist and confirmed diagnosis were used to determine diagnostic delays. Data from 393 children (65% girls, median age 7 years, range 7 months to 18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. Median duration from first symptom(s) to visit to paediatric gastroenterologist was 5 months (range 0-10 years; preschool 4 months, school-aged 5 months), and further duration until final diagnosis was 1 month (range 0-5 years) with significant regional differences (P < 0.001). Median diagnostic delay was 6 months (range 0-10 years; preschool 5 months, school-aged 7 months). Type of clinical presentation had little, however, significant effect on delays. Reduced body mass in delays longer than 3 years compared with delays shorter than 1 year was found (z score -0.93 vs -0.39, P < 0.05). Time from first symptoms to CD diagnosis in children in 5 CE countries is slightly shorter compared with few other small paediatric studies, and significantly shorter than reported for adults. Nevertheless, delays of more than 3 years in 6.6% of children are worrisome. Raising awareness about the variable symptoms and implementation of reliable diagnostic tools will further reduce diagnostic delays.

An Innovative Effective Nutritional Therapy for Vitamin D Deficiency in Children with Celiac Disease

Children with celiac disease (CD) are susceptible to reduced bone mineral density (BMD). Our target is to assess the severity of vitamin D deficiency in CD children on a gluten-free diet (GFD), and to evaluate the effectiveness of adding an innovative GF meal, on the clinical and bone biochemical indices of CD patients. 50 CD children who were diagnosed and followed up at Pediatric gastroenterology clinic, Specialized pediatric hospital, Cairo University; by serology and biopsy of the duodenum were included in this prospective study. CD children were on GFD for at least one year. As a control group, 40 healthy children were enrolled. Thorough clinical examination, anthropometric assessment, a complete history and 24 hours dietary recall were done for all the participants in this work. We introduced our innovative GF meal to CD patients twice/day, for 3 consecutive months. Venous blood samples were withdrawn from patients at the study beginning and after 3 months for detection of serum vitamin D, calcium, phosphorous and alkaline phosphatase levels. The anthropometric measurements, serum vitamin D, and calcium were markedly decreased in CD children than that of controls. In CD patients, a significant increase in anthropometric parameters, vitamin D and calcium were found. While there was a significant decline of serum alkaline phosphatase, and a slight decrease in serum phosphorus at the study end. The innovative gluten-free prepared meal confirmed to be of high nutritional value in the management of vitamin D deficiency and improvement of bone indices in CD patient.

A Survey of Fecal Calprotectin in Children with Newly Diagnosed Celiac Disease with Villous Atrophy

Background: Fecal calprotectin (FC) has been used as a diagnostic marker in intestinal inflammatory conditions. Objectives: As a few studies have been dedicated to assess the role of FC in coeliac disease (CD), the current study aimed to address this issue. Methods: This study included 70 newly diagnosed CD (Marsh score 3) and 70 healthy children. The study was performed at the pediatric ward of Amir-Al-Momenin Hospital in Zabol city, the southeast of Iran, during June 2016-September 2017. The FC level was determined using a specific ELISA kit. Results: Women constituted 64.3% (45/70) and 55.1% (38/70) of CD and healthy children, respectively (P = 0.1). Three was no significant difference in the mean age between children with CD (6.3 ± 3.4) and without CD (8.3 ± 4.5) (P = 0.2). The mean level of FC was significantly higher in patients (239.1 ± 177.3 μg/g) than in healthy controls (38.5 ± 34.6 μg/g, P < 0.001). The titer of anti-tTG was significantly higher in patients than in healthy children (205.9 ± 156.2 U/mL vs. 6.7 ± 2.1 U/mL, respectively, P < 0.001). There was a significant correlation between the FC level and anti-tTG titer (r = 0.611, P < 0.001). However, the correlation was not statistically significant between FC and age (r = -0.154, 0.07). The ROC curve analysis revealed an AUC value of 0.893 (95% CI: 0.827 - 0.960, P < 0.001). At the level of 50 μg/g, FC rendered the sensitivity and specificity of 90% and 92%, respectively, for the diagnosis of CD. Positive predictive value (PPV) and negative predictive value (NPV) of FC at this cutoff value were 95.5% and 90.5%, respectively. Conclusions: FC can be considered a screening complementary tool for detecting CD with high sensitivity and specificity.

HLA-DQB1*02 allele in children with celiac disease: Potential usefulness for screening strategies.

Through a retrospective analysis of a real-life cohort of children with celiac disease(CD), who underwent HLA-DQ genotyping, we supported our previous findings indicating the presence of HLA-DQB1*02 allele in at least 90%-95% of pediatric patients. In the present study, reporting the HLA-DQ analysis from 184 children (age range: 1-16years) diagnosed with CD in a single centre, we found that 97.29% of all these CD children (n=179 out of 184 genotyped patients) resulted to be carriers of at least one copy of HLA-DQB1*02 allele. If a widened screening for CD should result tobeappropriate in the pediatric population afterfurther clinical research,this observation might be potentially exploited to consider a two-step screening strategy, starting with the HLA-DQB1*02 targeted analysisfollowed by the specific serology for CD in these predisposed patients only. However, additional and larger studies are needed to support our findings.

Response to gluten free diet in sero-positive celiac disease children suffering from severe acute malnutrition in age group 1-5 years

Background: Diagnosis of celiac disease in children suffering from severe acute malnutrition without duodenal biopsy or HLA typing is a dilemma. The objective of this study was to study the response to gluten free diet in sero-positive Celiac Disease children suffering from severe acute malnutrition in age group 1-5 years.Methods: This prospective, observational, hospital-based study was conducted at MTC of tertiary care medical college hospital of southern Rajasthan from Dec. 2017 to Nov. 2018. Total 110 children with SAM were enrolled and screened for celiac disease on the basis of tissue tTg-IgA/IgG serology. Seropositive cases were kept on gluten free diet for short period of time and observed for the resolution of symptoms and improvement in growth, monitored by anthropometry on discharge and follow up visit.Results: Mean weight gain (gm/kg/day) on follow up was 3.87±3.49 in seropositive and 1.88±3.79 in seronegative cases (P-value&lt;0.05). Mean weight gain was 6.43±3.28gm/kg/day in only tTg-IgA positive and 3.04±2.95 gm/kg/day in only tTg-IgG positive cases (P-value-&lt;0.05). The mean weight gain in strictly gluten free adherent sero-positive cases was 4.89±2.97 gm/kg/day while in gluten free non-adherent patients it was -0.49±1.70 (P-value &lt;0.001). Mean weight gain in probable (tTg-Ig-A &lt;10 times ULN) and presumptive (tTg-IgA &gt;10 times ULN) Celiac disease were 3.44±3.73 and 5.44±3.78, respectively without statically significant difference (P-value &gt;0.05).Conclusions: In situations where facility of duodenal biopsy and or HLA DQ2/DQ8 typing is not available, resolution of symptoms and improvement in growth on gluten free diet confirms the diagnosis of celiac disease.

Early-life exposure to common virus infections did not differ between coeliac disease patients and controls.

Our aim was to compare the presence of various common viruses (rhinovirus, enterovirus, adenovirus, Epstein-Barr virus, cytomegalovirus, norovirus, parechovirus) in stool and nasal swab samples as well as virus-specific antibodies in serum samples between children who developed coeliac disease and controls. A case-control study was established based on the DIABIMMUNE Study cohorts. During the study, eight Estonian children and 21 Finnish children aged 1.5years to five years developed coeliac disease and each was matched with a disease-free control. Nasal swabs and stool samples were taken at the age of three to six months and the serum samples at the time of diagnosis. Rhinovirus ribonucleic acid was detected in the nasal swabs from five coeliac disease children, but none of the control children (p=0.05). There were no statistically significant differences in the level of viral antibodies between cases and controls. Enterovirus immunoglobulin G class antibodies were found more frequently in the Estonian than in the Finnish children (63% versus 23%, p=0.02). This study did not find any marked overall differences in laboratory-confirmed common viral infections between the children who developed coeliac disease and the controls. However, rhinovirus infections were detected slightly more often in those patients who developed coeliac disease.

Effect of gluten-free diet and compliance on quality of life in pediatric celiac disease patients.

BackgroundQuality of life (QOL) in children with celiac disease (CD) has been sparsely studied.AimsWe aimed to study QOL in pediatric CD and the effect of a gluten‐free diet (GFD) in a North Indian population.MethodsQOL was assessed at baseline and 6 months after GFD using a pediatric symptom checklist (PSC) score. The effect of GFD was assessed using a CD‐specific questionnaire on domains such as dietary compliance, parental behavior and perceptions, children's feeling, and difficulty identifying gluten‐free foods.ResultsA total of 60 CD children (age 6.03 ± 0. 42 years, range: 2–12 years, M:F 2:1) were prospectively enrolled. The median PSC score at baseline was 11.5 (2–35), which showed a statistically significant improvement after GFD to 2.5 (0–34) (P < 0.001). Significant concerns regarding specific domains emerged: difficulty in maintaining GFD 26.2%, at school 14.3%, at parties 43.2%, poor taste 11.4%, special diet a burden 28.5%, felt left out at school or friend's home 40.9%, felt different from other kids 40.9%, felt embarrassed to bring GFD to parties 54.6%, felt angry about following a special diet 56.8%, felt not invited out for meals because of CD 13.6%, and difficulty determining if food available was gluten free in 75%.ConclusionGFD has a significant impact on emotional, behavioral, and psychosocial domains in children with CD. Proper labeling of commercially available food items, counseling, and patient support groups are the need of the hour.

Health related quality of life among Saudi children and adolescents with celiac disease.

Background/Aims:Celiac disease (CD) is an immune-mediated enteropathy triggered by gluten ingestion in genetically susceptible individuals. This study reports on the quality of life (QOL) of Saudi children and adolescents with CD.Patients and Methods:This is a case control study that included Saudi patients with CD, aged 9-18 years, who attended CD Clinic at KAU between February 2017 and July 2018. The study was conducted using the Short-Form (SF-36) questionnaire for all candidates, CD-specific QOL questionnaire for the CD patients group, and CD screen questionnaire for the control group.Results:Overall, 354 subjects were studied (111 CD patients and 243 control). Female subjects constituted 56.8% of both patient and control groups. In the generic SF-36 questionnaire, QOL was comparable between patients and controls in all domains except for the general health domain, which showed difference in favor of the controls (55.01 ± 26.41 and 62.96 ± 18.16, P = 0.005). We also found that males have lower QOL scores in the domains comprising health change (P = 0.02), physical functioning (P = 0.04, role functioning/emotional and emotional well-being (P = 0.049). The CD-specific QOL showed excellent and good scores for 79.3% of patients overall in the tested domains. Patients with poor adherence showed poor QOL in all generic (SF-36) domains but not in CD-specific domains.Conclusion:The HRQOL for Saudi CD children on GFD is generally comparable to the healthy control with exception of the general health domain. Adherence to the GFD improves the generic (SF-36) QOL domains.

Evaluation of Gluten-free Diet on the Heart Functions in Children with Celiac Disease

Background Celiac disease (CD) is an autoimmune mediated gluten sensitive enteropathy and a chronic inflammatory condition caused by immune pathology in the small intestines in genetically susceptible individuals. This study aimed to determine the efficacy of gluten free diet on cardiac functions using conventional and Doppler tissue echocardiography (DTE) in children with CD compared to controls. Materials and Methods This case-control study was conducted on 107 children with CD and 45 healthy children. The study was performed in the Ali Ebne Abi Talib hospital, affiliated to Zahedan University of Medical Sciences, Zahedan (ZaUMS), Iran. After considering exclusion criteria, participants underwent echocardiography. Data were analyzed through SPSS software version 20.0. Results: Results showed that tTG-IgA was different in participants. Left MPI was different in control-positive (p<0.001), control-newly diagnosed (p=0.024), and positive-negative (p<0.001). Right MPI was different in control-positive (p<0.001), control-newly diagnosed (p=0.024), positive-negative (p<0.001), and negative-newly diagnosed (p<0.001). Left MPI’ was different in control-positive (p<0.001), control-newly diagnosed (p<0.001), positive-negative (p=0.014), and negative-newly diagnosed (p=0.010). Right MPI’ was different in control-positive (p<0.001), control-newly diagnosed (p<0.001), positive–negative (p=0.010), and negative-newly diagnosed (p=0.034). Left DT was different in positive-negative. Right ET was different in control-positive, control-newly diagnosed, positive-negative and negative-newly diagnosed. Right AT was different in positive-negative and positive-newly diagnosed. Conclusion It was concluded in patients with positive response to gluten free diet that some heart functions were similar to the controls and in patients with negative response, some were similar to newly diagnosed patients. Diastolic and systolic dysfunctions are important findings in CD children and TDE is a better method to identify cardiac involvements in subclinical patients with CD.

Linear growth of children with celiac disease after the first two years on gluten- free diet: a controlled study.

Background: Celiac disease (CD) is a lifelong disorder with gluten-induced manifestations in different organs especially growth. Gluten free diet (GFD) is required to achieve remission and prevent abnormal growth. Study reports on growth of children with celiac disease on long-term GFD are not consistent. Objective: We evaluated the effect of GFD on growth of children with the classical form of CD (diagnosed by serology and small intestine mucosal biopsy) on log-term GFD (>2 years). Methods: We studied growth parameters (weight gain/day, BMI and BMI-SDS, height growth velocity, Ht-SDS) and lab data in 30 prepubertal children, aged 7.4±2.6 years, with CD, who were on GFD since the age of 3.2±1.6 years of age (>2 years on GFD) for duration of 1 year. The anthropometric data of 30 randomly selected normal, age and sex matched, children were used as control. Lab investigations of CD children included complete blood count (CBC), renal and liver functions (aspartate transaminase - AST, alanine aminotransferase - ALT, and alkaline phosphatase- ALP, serum albumin, fasting blood glucose, vitamin D, and thyroid function and antibodies. Results: The weight gain per day was on average or above, for age and sex, in 27 children and below average in 3. Two out of those 3 children had slow linear growth (decreased Ht-SDS by -0.56 and -0.1, over one year). BMI-SDS was normal in 26/30 patients (>-1.5). BMI-SD changed from -0.36±1.1 to -0.33±1.1 during the year of treatment. BMI-SDS decreased in 9 children during the follow up period that was explained by their fast-linear growth (increased Ht-SDS) in seven of them. The Ht-SDS was <-2 in four out of 30 children at the beginning of the study (2 years after being on GFD) and in 2 children after a year of follow-up (catch-up growth). Ht-SDS remained normal or increased in 28/30 children during the year of treatment (-0.38 ±1.2 to -0.22±1.1), with a positive trend: 0.15±0.4 SDS. Only one patient crossed down 1 Ht-SDS during the year of follow up, with low weight gain/day and decreased BMI-SDS that can be explained by poor compliance with GFD. Ht-SDS and BMI-SDS increased significantly in the CD group versus controls during the year of follow-up. All patients had normal serum albumin, liver enzyme and hemoglobin levels. 33.3% of patients had low serum ferritin level and 33.3% had a vitamin D deficiency. Conclusions: Most of our children with CD grew normally both in height and weight during GFD. Significant catch-up growth occurred in some of them after 2 years of being on GFD. Those with low BMI-SDS and/or Ht-SDS needed further management, including reinforcement on the importance of GFD and investigations on factors affecting growth pattern. Measuring weight gain /day appears to be a sensitive indicator for monitoring growth in these children. Vitamin D and iron status should be monitored, and deficiencies corrected. (www.actabiomedica.it)

Compliance with gluten-free diet in a selected group of celiac children in the Slovak Republic.

Celiac disease (CD) is a chronic long-term disease with autoimmune disorder connected to an allergic reaction to the molecule of gluten. CD is manifested in persons who are genetically predisposed. The only therapy for CD is a strong gluten-free (GF) diet. The aim of our study was to follow the adherence to the gluten-free diet in the selected group of parents and caregivers of children with CD, and to compare factors influencing the adherence to GF diet and therefore influencing also clinical symptoms of CD. We compared and examined important food-related activities as well, by using a personal questionnaire in the group of CD children's parents or caregivers. We designed a cross-sectional study; 325 parents or caregivers of children with CD were recruited in the sample. CD was confirmed by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) criteria. The anonymous questionnaires were collected at summer camps within period data 2012-2016 and followed factors which might have an influence on compliance with GF diet, according to parents' opinions. Adherence to GF diet was statistically significantly higher among girls compared to boys. Parents' questionnaires confirmed that younger group of children and children with the family history of CD had statistically higher compliance with GF diet. Parents with higher education confirmed better adherence to GF diet, statistical analyses confirmed higher adherence in mother´s education compared to father's education. Duration of CD, socio-demographic factors of parents - age of parent, gender of parent, and residency were not statistically significant in terms of compliance with the diet. Our study confirmed important factors influencing adherence to the GF diet, which are connected to the symptoms and consequences of CD. The assessment of parents' opinions and burden on the families of children with celiac disease should be also reflected in the evaluation of patient's status. Important is also the role of parents in order to facilitate and support clinical interventions and prevention of CD.