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Growth failure and insulin-like growth factor (IGF-I) in childhood celiac disease
I Eichler1, H Frisch, G Granditsch
1Universitätskinderklinik, Wien.
Insights
Childhood celiac disease (CCD) often presents with underweight and short stature, even in children with normal growth metrics. Early diagnosis is crucial, as insulin-like growth factor (IGF-I) levels improve on a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Genetics
Background:
- Childhood celiac disease (CCD) is an autoimmune disorder triggered by gluten ingestion.
- Growth abnormalities, including underweight and short stature, are common manifestations of CCD.
- Insulin-like growth factor I (IGF-I) plays a critical role in childhood growth and development.
Purpose of the Study:
- To assess the prevalence of underweight, short stature, and laboratory abnormalities in biopsy-verified childhood celiac disease.
- To investigate the relationship between gluten exposure, IGF-I levels, and growth failure in children with CCD.
- To evaluate the impact of a gluten-free diet on IGF-I levels in CCD patients.
Main Methods:
- Retrospective analysis of 335 patients with biopsy-verified CCD to determine the prevalence of growth issues.
- Prospective study of 62 patients (32 CCD, 30 controls) undergoing jejunal biopsy to measure serum IGF-I levels.
- Correlation analysis between duration of gluten exposure, IGF-I levels, and growth parameters.
Main Results:
- 67.4% of CCD patients younger than 2 years were underweight, and 33.9% were short.
- In CCD patients older than 2 years, 36.0% were underweight and 50.0% were short.
- IGF-I levels were significantly lower in female CCD patients and negatively associated with gluten exposure duration, though reduction occurred before overt growth failure.
- A gluten-free diet led to rapid normalization of IGF-I levels.
Conclusions:
- Diagnostic workup for CCD is warranted in all children with unexplained short stature.
- Normal height and weight do not exclude CCD in symptomatic children.
- IGF-I levels are a sensitive indicator of metabolic disturbance in CCD and normalize with dietary treatment.
Abstract:
The prevalence of underweight, short stature, and abnormal laboratory tests was assessed in a retrospective study of 335 patients with biopsy-verified childhood celiac disease (CCD). Of the patients younger than 2 years old, 67.4% were underweight (body weight: less than - 2SD) and 33.9% were short (height: less than - 2SD). In children older than 2 years, underweight was present in 36.0% of patients; the prevalence of short stature was 50.0%. Therefore, diagnostic procedures related to CCD appear justified in all children with short stature of unknown etiology. However, because 50% of patients were neither short nor underweight, normal height and weight should not preclude workup of a patient with symptoms suggestive of CCD. Of the laboratory tests evaluated, antigliadin antibodies were the most sensitive for CCD. Insulin-like growth factor (IGF-I) serum levels were prospectively studied in 62 patients (32 CCD patients, 30 controls) referred for jejunal biopsy. IGF-I levels were significantly lower in female CCD patients than in control patients. There was a significant negative association between the duration of gluten exposure and IGF-I levels. Results indicate that significant reduction in IGF-I levels in CCD patients occurs only after prolonged gluten exposure but before growth failure. Reevaluation of IGF-I levels on a glutenfree diet showed rapid reversal of reduced IGF-I values.