Obesity in pediatric celiac disease

Celiac disease (CD) is a T cell-mediated chronic autoimmune enteropathy occurring in genetically susceptible individuals, and manifested by a permanent intolerance to gluten-containing products. CD commonly presents in children as failure to thrive and malabsorption or after screening high-risk groups such as people with diabetes. Almost half of adult patients with CD have a body mass index (BMI) >25 at diagnosis. Classic symptoms like diarrhea are less common in obese patients. Few children have been reported with CD and obesity. Because many children with newly diagnosed CD are identified by screening high-risk groups, obesity is more common than previously suspected. The aim of the study was to estimate the prevalence of obesity at diagnosis in children with CD and to describe the clinical characteristics of this group.

This is a retrospective study of 143 patients with CD diagnosed between 1986 and 2003 at Children's Hospital of Wisconsin. Data collected included patient's age, sex, ethnicity, presenting signs and symptoms, BMI, celiac antibody titers, small-intestinal biopsy results, and follow-up weight 1 year after initiating a gluten-free diet (GFD).

Seven of the 143 (5%) patients had BMI >95th percentile. The most common presenting symptoms among obese patients were abdominal pain, diabetes, and diarrhea. Symptoms improved in all of the patients on a GFD. BMI decreased in 4 (50%), increased in 2 (25%), and was not available in 1 patient at 1 year after starting on GFD.

Obesity is more common in children with CD than previously recognized. In the appropriate clinical setting, CD must be considered even in obese children.