BMI Status of Children with Celiac Disease Has Changed in the Last Decades: A 30-Year Retrospective Study

Area of Science:

• Pediatric Gastroenterology
• Clinical Nutrition
• Immunology

Background:

• Celiac disease (CD) diagnosis in children historically presented with malabsorption-related symptoms and underweight status.
• Recent trends suggest a change in CD presentation, with an increase in children exhibiting normal or elevated body mass index (BMI).

Purpose of the Study:

• To analyze the changes in BMI distribution among children diagnosed with celiac disease over three decades.
• To compare the clinical and serological characteristics of children with celiac disease across different BMI categories and diagnostic periods.

Main Methods:

• Retrospective review of pediatric celiac disease patient data from a single center.
• Comparison of BMI distribution, clinical symptoms, and serological markers between two cohorts: 1990-2011 and 2012-2022.
• Statistical analysis of prevalence rates for underweight, overweight, and obese children with CD.

Main Results:

• The prevalence of underweight children with CD significantly decreased from 24.4% (1990-2011) to 12.7% (2012-2022).
• Conversely, the prevalence of overweight and obese children with CD significantly increased from 4% and 0.4% to 9.9% and 3.3%, respectively.
• Gastrointestinal symptoms were more frequent in overweight/obese children with CD compared to underweight children in both cohorts.

Conclusions:

• The presentation of celiac disease in children has evolved, with a notable increase in normal or overweight/obese individuals.
• Celiac disease should be suspected in children irrespective of their BMI, challenging traditional diagnostic assumptions.
• Further research into the changing epidemiology and clinical manifestations of pediatric celiac disease is warranted.