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Anemia and Iron Deficiency in Children With Potential Celiac Disease
Marleena Repo1, Katri Lindfors, Markku Mäki
1*Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital †Tampere School of Health Sciences, University of Tampere, Tampere ‡Molecular Genetics of Immunological Diseases Group, University of Helsinki, Helsinki §Department of Internal Medicine, Tampere University Hospital ||School of Medicine, University of Tampere, Tampere, Finland.
Insights
Anemia and iron deficiency can be present in children with potential celiac disease, even with normal villous morphology. Early diagnosis and gluten-free diet may be beneficial for these children.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Nutritional Science
Background:
- Celiac disease screening often identifies children with potential celiac disease (seropositive with normal villi).
- The necessity of treatment for these children remains uncertain.
- This study investigates anemia and iron deficiency in children with potential celiac disease and varying degrees of villous atrophy.
Purpose of the Study:
- To determine the prevalence of anemia and iron deficiency in children with potential celiac disease and mucosal atrophy.
- To compare these findings with healthy controls.
- To assess the impact of a gluten-free diet on these parameters.
Main Methods:
- Prospective study including children with potential celiac disease (n=19), partial/subtotal villous atrophy (P/SVA, n=67), total villous atrophy (TVA, n=16), and healthy controls (n=23).
- Evaluation of clinical, histological, and laboratory parameters, including hepcidin.
- Comparison of anemia, iron status (iron, transferrin receptor, ferritin, transferrin saturation), folate, and vitamin B12 levels across groups.
Main Results:
- Anemia prevalence: 0% (controls), 15% (potential), 22% (P/SVA), 63% (TVA).
- Iron deficiency markers (low iron, high transferrin receptor, low ferritin, low transferrin saturation) increased with villous atrophy severity.
- Children with P/SVA showed improved hemoglobin, iron, ferritin, and albumin after a gluten-free diet.
Conclusions:
- Anemia and iron deficiency in celiac disease represent a continuum.
- These deficiencies can be present even in children with potential celiac disease and normal villous morphology.
- Early diagnosis and potential dietary intervention are advocated for these pediatric patients.
Objectives:
Active screening for celiac disease frequently detects seropositive children with normal villous morphology (potential celiac disease). It remains unclear whether these subjects should be treated. We here investigated the prevalence of anemia and iron deficiency in children with potential and mucosal atrophy celiac disease.
Methods:
The prospective study involved 19 children with potential disease, 67 with partial or subtotal villous atrophy (P/SVA), and 16 with total villous atrophy (TVA). Twenty-three healthy children comprised the control group. The groups were compared for various clinical, histological, and laboratory parameters and hepcidin.
Results:
The prevalence of abnormal parameters was as follows (controls, potential celiac disease, P/SVA, and TVA, respectively): anemia 0%, 15%, 22%, and 63%; low iron 5%, 0%, 14%, and 50%; increased transferrin receptor 1 5%, 16%, 20%, and 47%; low ferritin 0%, 21%, 35%, and 87%; and low transferrin saturation 10%, 11%, 41%, and 71%. One subject had low folate and none had low vitamin B12. The median values for hemoglobin, total iron, ferritin, and transferrin saturation were significantly lower and transferrin receptor 1 values higher in TVA group compared with other groups. After a median of 7 months on a gluten-free diet hemoglobin, total iron, ferritin, and albumin in children with P/SVA exceeded the baseline values in the potential celiac disease group.
Conclusions:
The development of anemia and iron deficiency in celiac disease is a continuum and may already be present in children with normal villous morphology, advocating an early diagnosis and possible dietary treatment of these patients.
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