Early growth in children with coeliac disease: A cohort study
Kahrs CR, Magnus MC, Stigum H et al
Archives of Disease in Childhood 2017; 0: 1-7. Doi: 10.1136/archdischild-2016-312304
Impaired growth is a common and early manifestation of ‘classic’ coeliac disease in children, however the majority do not have a growth disturbance of sufficient magnitude to lead to diagnosis. This study aimed to investigate whether growth in the first 2 years of life differs between children later diagnosed with coeliac disease and children without the diagnosis in a large, prospective birth cohort.
Archives of Disease in Childhood 2017; 0: 1-7. Doi: 10.1136/archdischild-2016-312304
Impaired growth is a common and early manifestation of ‘classic’ coeliac disease in children, however the majority do not have a growth disturbance of sufficient magnitude to lead to diagnosis. This study aimed to investigate whether growth in the first 2 years of life differs between children later diagnosed with coeliac disease and children without the diagnosis in a large, prospective birth cohort.
Data for this study was extracted from the Norwegian Mother and Child Cohort Study (MoBa), a prospective population-based pregnancy cohort study that now includes more than 112,000 children born between 1999-2009. MoBa data comprises information from questionnaires administered on recruitment (18 weeks gestation), and when the child was 6, 18 and 36 months of age. Weights and lengths at birth, 3, 6, 8, 15-18 and 24 months for participating children were collected from Medical Birth Registry of Norway. Coeliac disease was identified through combined data from MoBa questionnaires and the Norwegian Patient Register.
During a median follow-up of 8.6 years, 440 children were diagnosed with coeliac disease (0.75%). Alongside these, sufficient follow-up data was available for 58,235 cohort controls. In the cross-sectional analysis, height growth differed in the first year of life between coeliac disease children and cohort controls. The reduction accelerated and became significant between 12 and 24 months, corresponding to a difference of 0.8cm at 2 years of age. Children later diagnosed with coeliac disease were non-significantly lighter already at birth. The difference was significant from 15-18 months and then gradually increased, corresponding to a difference between cases and cohort controls of approximately 250g at 24months. The mean age at coeliac disease diagnosis was 4.4 years, and the mean time from start of symptoms recorded by parents until diagnosis was 6 months. Excluding children with debut symptoms or diagnosed before 2 years of age yielded largely similar results as the main analysis.
Growth retardation in coeliac disease may be explained by malnutrition due to villous atrophy, but the evidence for this is scant. Other possible mechanisms are systemic inflammation, disturbance in the growth hormone axis and increased prevalence of antipituitary antibodies. The results of this study indicate that overall growth in height may be affected as early as 12 months of age and that growth impairment commonly starts before other symptoms. As low-grade enteropathy may occur without sero-conversion in adults, the authors speculate that growth may be impaired earlier than seroconversion. Longitudinal studies of growth from birth and repeated screening for coeliac disease are needed to further elucidate the nature of underlying mechanisms of growth restriction.
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During a median follow-up of 8.6 years, 440 children were diagnosed with coeliac disease (0.75%). Alongside these, sufficient follow-up data was available for 58,235 cohort controls. In the cross-sectional analysis, height growth differed in the first year of life between coeliac disease children and cohort controls. The reduction accelerated and became significant between 12 and 24 months, corresponding to a difference of 0.8cm at 2 years of age. Children later diagnosed with coeliac disease were non-significantly lighter already at birth. The difference was significant from 15-18 months and then gradually increased, corresponding to a difference between cases and cohort controls of approximately 250g at 24months. The mean age at coeliac disease diagnosis was 4.4 years, and the mean time from start of symptoms recorded by parents until diagnosis was 6 months. Excluding children with debut symptoms or diagnosed before 2 years of age yielded largely similar results as the main analysis.
Growth retardation in coeliac disease may be explained by malnutrition due to villous atrophy, but the evidence for this is scant. Other possible mechanisms are systemic inflammation, disturbance in the growth hormone axis and increased prevalence of antipituitary antibodies. The results of this study indicate that overall growth in height may be affected as early as 12 months of age and that growth impairment commonly starts before other symptoms. As low-grade enteropathy may occur without sero-conversion in adults, the authors speculate that growth may be impaired earlier than seroconversion. Longitudinal studies of growth from birth and repeated screening for coeliac disease are needed to further elucidate the nature of underlying mechanisms of growth restriction.
Link to original article
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