Growth Screening Can Spot Celiac Disease Early in Childhood

By Megan Brooks

NEW YORK (Reuters Health) - Screening boys and girls for growth parameters may help detect celiac disease early, as well as growth disorders in general, say researchers from Finland.

Celiac disease is under diagnosed during childhood. The immune-related disorder triggered by gluten includes a variety of nonspecific symptoms including poor growth, Dr. Antti Saari, Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital in Kuopio, and colleagues say.

They developed five age- and sex-specific growth-screening parameters in a reference population of more than 51,000 healthy children: height standard deviation score (HSDS) and body mass index (BMI) SDS distance from the population mean, distance from target height, and change in HSDS and BMI SDS. They evaluated these parameters in 177 children with celiac disease by analyzing growth data from birth until diagnosis of celiac disease.

The researchers say celiac disease was detected with "good accuracy" when screening included all five growth parameters (AUC 0.88 for girls and 0.84 for boys).

At the time of diagnosis, the mean HSDS and BMI SDS were -0.45 and -0.25, respectively, in girls and -0.58 and -0.44, respectively, in boys.

Girls with celiac disease were shorter than the reference population two years before diagnosis and boys were shorter than the reference population one year before diagnosis (p<0.05).

In email to Reuters Health, Dr. Saari said, "Systematic population-based screening of linear growth would facilitate early diagnosis of celiac disease in children. Faltering linear growth might be the earliest sign of symptomless celiac disease. In addition, systematic growth monitoring is not only effective for early detection of celiac disease, but also in growth disorders in general. Thus, systematic population-based screening of linear growth might be utilized more effective in clinical practice for detecting growth disorders in children."

The researchers add in their paper, published online March 2 in JAMA Pediatrics, "Owing to the complex nature of evidence-based growth screening, this process should ideally be performed using computerized screening algorithms integrated into electronic health record systems."

The researchers also note that recurrent abdominal pain was the most common symptom preceding the diagnosis of celiac disease. Most children had an increased level of immunoglobulin A antibodies against tissue transglutaminase and endomysial antibody.

Related research published March 2 in Pediatrics suggests that genetic susceptibility screening for celiac disease is worthwhile. Dr. Daniel Agardh from Lund University, Malmo, Sweden, and the international TEDDY study team report that children who develop celiac disease antibodies may show early gastrointestinal issues or growth concerns, but by age three or four, most become asymptomatic and therefore could go undiagnosed without screening.

In email to Reuters Health, Dr. Agardh said the take-home message is, "You must screen with disease specific-antibodies in order to detect celiac disease in young children; you cannot only rely on parents perception of their child's symptoms."

The author of related commentary says, "Armed with emerging data that document a benefit from the dietary treatment of individuals with asymptomatic or mildly symptomatic celiac disease, a two-tiered approach that includes newborn or early-life screening for genetic susceptibility, coupled with later screening for celiac-specific antibodies, has been proposed."

"With awareness and availability of gluten-free foods increasingly entrenched within the mainstream of the North American lifestyle, the burden lies on the identification of all children who may benefit from treatment," writes Dr. Richard Noel of Duke University Medical Center, Durham, North Carolina.

"The prospective data from TEDDY effectively demonstrate the value of two-tiered screening and constitute a step forward in devising a population-screening strategy that best offers the appropriate treatment at a stage in life where it may yield the most lifelong benefit," he concludes.

SOURCES: http://bit.ly/1vTpeDa

JAMA Pediatr 2015.

http://bit.ly/1M3DeOG and http://bit.ly/1vSKA3K

Pediatrics 2015.

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