Background Positive anti-tTG levels have been associated with reduced weight and bone mineral density (BMD) in clinical celiac disease (CD). However, effects in subclinical CD are not known.
Objective To assess associations between anti-tTG levels, growth and BMD in children with subclinical CD.
Methods In a population-based prospective cohort study, serum samples were analysed for anti-tTG levels at 6 years of age. (n = 4,442) Children were categorised into 2 groups: negative (< 7 U/ml, n = 4,249), or positive anti-tTG ( >7 U/ml, n = 57). Positive tTG levels were further categorised into 2 categories based on the > 10 times upper limit of normal (ULN) levels (70 U/ml). Height, weight and BMI z-scores were obtained using Dutch reference growth charts. BMD was measured by Dual-energy X-ray absorptiometry (DEXA). Multivariable linear regression and linear mixed models were performed.
Results Delayed growth in weight SDS/year (-0.05; 95% CI -0.09,-0.01) and BMI SDS/year (-0.10; 95% CI -0.18, -0.01) from 6 months until 6 years was observed in children with positive anti-tTG levels. Height growth tended to be delayed over time (-0.02 SDS/year; 95% CI -0.06, 0.02). A lower height (-0.29; 95% CI -0.55,-0.04), weight (-0.38; 95% CI -0.64,-0.12), BMI (-0.26 95% CI -0.49,-0.03) and BMD (-0.26; 95% CI -0.45, -0.08) at 6 years of age was found in children with positive anti-tTG levels.
Conclusion Positive anti-tTG levels in children without gastrointestinal symptoms at 6 years of age were associated with reduced BMD and delayed growth trajectories until 6 years. This suggests that subclinical CD has consequences for BMD and normal growth.