Iron supplementation in children with celiac disease

Area of Science:

• Pediatric Gastroenterology
• Hematology
• Nutrition

Background:

• Celiac Disease (CD) is an autoimmune disorder triggered by gluten ingestion.
• Iron deficiency anemia (IDA) is a frequent complication in children with CD.
• The long-term hematological impact of a gluten-free diet (GFD) combined with iron supplementation requires further investigation.

Purpose of the Study:

• To assess the effect of iron supplementation alongside a GFD on the hematological profile of pediatric CD patients.
• To compare hematological parameters of CD patients with age- and sex-matched controls.

Main Methods:

• Prospective evaluation of children diagnosed with CD.
• Assessment of hematological parameters including hemoglobin, complete blood counts, MCV, MCH, serum iron, TIBC, and ferritin.
• Comparison of parameters at enrollment and after at least one year on GFD with iron supplementation.
• Intestinal biopsy performed before and after GFD intervention.

Main Results:

• At enrollment, CD patients exhibited significantly lower hemoglobin, MCV, MCH, and ferritin levels, with higher TIBC compared to controls.
• After one year on GFD and iron supplementation, hemoglobin levels normalized, but MCV, MCH, ferritin remained lower, and TIBC higher than controls.
• Seven children still presented with mild anemia, and serum ferritin correlated negatively with villous atrophy severity.

Conclusions:

• Iron deficiency is prevalent in pediatric CD and may persist despite GFD and iron supplementation.
• Early detection and treatment of IDA, along with prophylactic iron and folic acid, are crucial for optimizing children's cognitive and psychomotor development.
• Dietary iron fortification within a GFD may be beneficial.