Nutritional status in pediatric celiac disease: evaluation at diagnosis and during follow-up

Celiac disease (CD) is a lifelong immune-mediated condition precipitated by gluten ingestion in genetically predisposed individuals, resulting in intestinal mucosal damage, impaired growth, micronutrient deficiencies, among other gastrointestinal and extraintestinal symptoms. A gluten-free diet (GFD) contributes to the healing of the mucosa and improves nutrient absorption, although recovery patterns may vary.

The present study aimed to determine changes in anthropometric parameters and micronutrient levels at diagnosis and at six and twelve months following the start of a GFD, and to investigate any associations between these changes and tissue transglutaminase IgA (tTG-IgA) status, the severity of mucosal damage, or clinical characteristics.

This retrospective investigation involved an assessment of pediatric individuals diagnosed with CD using anthropometric and micronutrient data collected at the point of diagnosis and at subsequent 6- and 12-month intervals following GFD. Dietary adherence was evaluated retrospectively using physician and dietitian follow-up notes, clinical assessment, and serial tTG-IgA measurements.

Among 103 children (64% female), 56% had no comorbidities, and type 1 diabetes was the most common (15%). Height, weight, body mass index, and most micronutrient levels improved during follow-up period. Vitamin D deficiency remained present in 27% of patients at 12 months and overweight prevalence increased from 7.8% to 18.4% during follow-up. Individuals presenting with comorbid CD+type 1 diabetes demonstrated higher SDS for weight and height, and elevated hemoglobin concentrations. The incidence of seronegativity was 55% at six months and 73% at twelve months.

Within a year, GFD enhances growth and resolves the majority of micronutrient deficiencies, however; ongoing nutritional monitoring is crucial due to persistent vitamin D deficiency and an increasing risk of overweight.