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Screening rules for growth to detect celiac disease: a case-control simulation study
Paula van Dommelen1, Floor K Grote, Wilma Oostdijk
1Dept. of Statistics, TNO Quality of life, Leiden, The Netherlands. paula.vandommelen@tno.nl
Insights
Slowed growth in children with celiac disease (CD) is often assumed but not always effective for diagnosis. Body mass index (BMI) decrease is the most sensitive indicator for symptomatic CD patients.
Area of Science:
- Pediatrics
- Gastroenterology
- Growth and Development
Background:
- Celiac disease (CD) is often associated with impaired growth in children.
- The diagnostic utility of growth parameters for identifying CD in children remains unclear.
- This study evaluates the effectiveness of various growth criteria in detecting CD.
Purpose of the Study:
- To assess the diagnostic efficiency of different growth criteria for identifying children with celiac disease.
- To compare the effectiveness of length, weight, and Body Mass Index (BMI) in detecting CD.
- To analyze growth patterns in CD patients with clinical manifestations versus those diagnosed via screening.
Main Methods:
- A case-control simulation study utilizing longitudinal growth data from birth to 2.5 years.
- Included three groups of celiac disease patients (n=134) and a reference cohort (n=2,151).
- Evaluated sensitivity, specificity, and positive predictive value (PPV) for each growth criterion.
Main Results:
- Body Mass Index (BMI) Standard Deviation Score (SDS) decrease was the most effective criterion for CD patients with clinical manifestations.
- Thirty percent of symptomatic CD children and 2% of controls had a BMI SDS < -1.5 with a decrease of at least -2.5 (PPV=0.85%).
- Growth criteria did not effectively distinguish screened CD children from the reference group.
Conclusions:
- A decrease in BMI SDS is the most sensitive growth parameter for celiac disease children presenting with clinical symptoms.
- BMI is a superior predictor of CD compared to weight, length, or height in symptomatic children.
- Celiac disease patients identified through screening exhibit normal growth patterns during early childhood.
Background:
It is generally assumed that most patients with celiac disease (CD) have a slowed growth in terms of length (or height) and weight. However, the effectiveness of slowed growth as a tool for identifying children with CD is unknown. Our aim is to study the diagnostic efficiency of several growth criteria used to detect CD children.
Methods:
A case-control simulation study was carried out. Longitudinal length and weight measurements from birth to 2.5 years of age were used from three groups of CD patients (n = 134) (one group diagnosed by screening, two groups with clinical manifestations), and a reference group obtained from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort (n = 2,151) in The Netherlands. The main outcome measures were sensitivity, specificity and positive predictive value (PPV) for each criterion.
Results:
Body mass index (BMI) performed best for the groups with clinical manifestations. Thirty percent of the CD children with clinical manifestations and two percent of the reference children had a BMI Standard Deviation Score (SDS) less than -1.5 and a decrease in BMI SDS of at least -2.5 (PPV = 0.85%). The growth criteria did not discriminate between the screened CD group and the reference group.
Conclusion:
For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS. BMI is a better predictor than weight, and much better than length or height. Toddlers with CD detected by screening grow normally at this stage of the disease.