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Growth monitoring could lead to earlier detection of celiac disease
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Most children with detected persistent transglutaminase autoantibodies were asymptomatic and had normal growth by age 4 years, according to study findings in Pediatrics.
Daniel Agardh, MD, PhD, of Lund University in Malmo, Sweden, and colleagues examined associations between celiac disease (CD) symptoms, known risk factors, tissue transglutaminase autoantibody (tTGA) levels and mucosal lesions among 6,706 children who tested positive for HLA-DR3-DQ2 or DR4-DQ8. Children were screened for tTGA annually. Symptoms were assessed via questionnaires.
Overall, 914 children developed persistent tTGA, 406 underwent biopsies for mucosal lesions, and 340 had confirmed CD.
Children with persistent tTGA were more likely to experience symptoms at age 2 years (34% vs. 19%; P < .001) and 3 years (28% vs. 19%; P = .009), but not at age 4 years compared with age-matched tTGA-negative children.
There were no variations in z scores for height, weight and BMI among groups.
A family history of CD was associated with having one or more symptoms among children with persistent tTGA (OR = 2.59; 95% CI, 1.21-5.57).
Symptomatic children (P < .001), children with a family history of CD (P < .001) and U.S. children (P < .001) had higher tTGA levels at seroconversion compared with asymptomatic children. Severity of mucosal lesions was associated with tTGA levels in symptomatic (P < .001) and asymptomatic children (P < .01).
“This prospective screening for CD showed that at least two-thirds of children have no symptoms at the time of seroconversion to tTGA positivity by 4 years of age,” Agardh and colleagues wrote. “Our findings may have implications for future screening of the general population and case-finding strategies in at-risk groups.”
In a similar sentiment, data published in JAMA Pediatrics suggest a growth-monitoring program could lead to earlier detection of CD, as the majority of children with CD had abnormal growth beforehand.
Antti Saari, MD, of the University of Eastern Finland, and colleagues assessed screening accuracy for detection of unusual growth among children with CD using longitudinal growth data from a nationwide Finnish cross-sectional study. The final cohort consisted of 177 children aged 0 to 16 years. Screening parameters included height standard deviation score and BMI standard deviation score distance from population mean, distance from target height, change in height standard deviation score and change in BMI standard deviation score.
Median age at diagnosis was 6.2 years among girls and 7.1 years among boys.
At diagnosis, mean height standard deviation score was –0.45 and BMI standard deviation score was –0.25.
Overall, girls were shorter than the reference population 2 years before CD diagnosis, while boys were shorter in comparison at 1 year before diagnosis (P < .05).
Screening for abnormal growth using any single screening parameter had poor to moderate accuracy, according to researchers. Using all five parameters collectively, however, performed better than any single parameter. Sensitivity of screening using all parameters together was 69% for girls and 61% for boys with a 90% specificity.
Analysis of longitudinal growth data from 5 years before diagnosis indicated cumulative prevalence of an abnormal screening result using the five parameters increased as diagnosis moved closer. If the specificity of growth screening was 90%, the cumulative percentage of children with abnormal growth prior to or at diagnosis was 82% for girls and 70% for boys.
“We showed that most children diagnosed as havingCD would have been detected by auxological screening, which is a simple and noninvasive method for improving the early diagnosis of CD in children,” Saari and colleagues concluded. “Most children with CD developed a growth failure prior to the diagnosis and, on average, children with CD were shorter than the healthy reference population.”
Measuring growth longitudinally rather than in separate measurements may produce optimal growth screening accuracy, according to the researchers. – by Amanda Oldt
Disclosure: The researchers report no relevant financial disclosures.
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