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A prospective study of catch-up growth among Indian children with celiac disease
Madhavi Bharadwaj1, Ashish Jain2, Anand Prakash Dubey1
1Department of Pediatrics, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India.
Insights
The gluten-free diet (GFD) significantly improves growth and biochemical markers in children with celiac disease (CD). Anemia severity correlates with Marsh biopsy grade, but GFD aids hemoglobin recovery in all cases.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Celiac Disease Research
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Diagnosis in children requires adherence to a strict gluten-free diet (GFD).
- Nutritional status and growth are critical indicators of treatment efficacy in pediatric CD.
Purpose of the Study:
- To evaluate the impact of a gluten-free diet (GFD) on growth and biochemical parameters in newly diagnosed pediatric celiac disease patients.
- To determine the association between Marsh biopsy classification and hematological parameter response during GFD follow-up.
Main Methods:
- A prospective observational study followed 51 children (aged 1-10 years) with newly diagnosed CD for 6 months after initiating a GFD.
- Anthropometric, biochemical, and hematological parameters were recorded at baseline and at 1, 3, and 6 months.
- Data analysis utilized SPSS version 21.0, with P < 0.05 considered significant.
Main Results:
- The GFD led to significant improvements in growth and biochemical parameters by 6 months (P < 0.05).
- Hemoglobin levels decreased with increasing Marsh biopsy grade (3A to 3C) at enrollment and 3 months.
- Children with Marsh 3C showed significantly better hemoglobin improvement post-GFD compared to Marsh 3A and 3B (P < 0.05).
Conclusions:
- The GFD is effective in improving growth and reducing anemia in children with celiac disease within 6 months.
- While higher Marsh biopsy grades correlate with increased anemia severity, GFD initiation leads to significant hemoglobin recovery over time.
Objectives:
The study was done to investigate the response of the gluten-free diet (GFD) on growth and other biochemical parameters in newly diagnosed children with celiac disease (CD). We also determined the association of Marsh biopsy classification and the response in haematological parameters among the children with GFD over the follow-up time.
Methods:
A prospective observational study was conducted for 1.5 years where children aged 1-10 years with newly confirmed CD (as per Marsh classification) without pre-existing chronic disease were enrolled. Individual anthropometry, biochemical and haematological parameters were recorded on enrolment and compared with 1, 3 and 6 months (follow-up) after initiating GFD (as per World Health Organization growth charts).
Statistical Analysis:
The data were entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences version 21.0. A P value of < 0.05 was considered significant.
Results:
A total of 51 (out of 55) children with CD completed 6-month follow-up. A significant improvement in the growth and biochemical parameters was seen at 6-month follow-up with the GFD (P < 0.05). There was a significantly decreasing Hb (at enrolment and at 3 months) with increasing Marsh biopsy grade-it was significantly less with Marsh 3C and more with Marsh 3A. A significantly better %Hb improvement was seen in children with Marsh biopsy 3C as compared to 3A and 3B (P < 0.05). We found no significant association of Marsh biopsy with Malabsorption, type of anaemia and Serum ferritin levels (P > 0.05).
Conclusions:
GFD showed significant improvement in the growth and development of the child with a significant reduction in anaemia at 6 months. With increasing grade of Marsh biopsy, the severity of anaemia increases but after the initiation of GFD, such children show significantly better improvement in %Hb over time.
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