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Original article
Early growth in children with coeliac disease: a cohort study
  1. Christian R Kahrs1,2,
  2. Maria C Magnus3,4,5,
  3. Hein Stigum3,
  4. Knut E A Lundin6,7,
  5. Ketil Størdal1,2
  1. 1 Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway
  2. 2 Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
  3. 3 Department of Non-Communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
  4. 4 MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  5. 5 School of Social and Community Medicine, University of Bristol, Bristol, UK
  6. 6 Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  7. 7 Centre for Immune Regulation, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Christian R Kahrs, Department of Pediatrics, Østfold, Hospital Trust, Kalnesveien 300, Grålum 1714, Norway; ckahrs79{at}gmail.com

Abstract

Objectives We aimed to study growth during the first 2 years of life in children later diagnosed with coeliac disease compared with children without, in a time with changing epidemiology and improved diagnostics.

Design A prospective population-based pregnancy cohort study.

Setting The nationwide Norwegian Mother and Child Cohort Study.

Patients 58 675 children born between 2000 and 2009 with prospectively collected growth data. Coeliac disease was identified through combined data from questionnaires and the Norwegian Patient Register.

Main outcome measures The differences in height and weight at age 0, 3, 6, 8, 12, 15–18 and 24 months using internally standardised age and gender-specific z-scores. Linear regression and mixed models were used.

Results During a median follow-up of 8.6 years (range 4.6–14.2), 440 children (0.8%) were diagnosed with coeliac disease at a mean age of 4.4 years (range 1.5–8.5). Children with coeliac disease had significantly lower z-scores for height from 12 months (−0.09 standard deviation scores (SDS), 95% CI −0.18 to −0.01) and weight from 15 to 18 months of life (−0.09 SDS, 95% CI −0.18 to −0.01) compared with cohort controls. The longitudinal analysis from 0 to 24 months yielded a significant reduction in height z-score per year (−0.07 SDS, 95% CI −0.13 to −0.01) but not for weight among children with coeliac disease. Excluding children diagnosed before age 2 years gave similar results.

Conclusions This study indicates that growth retardation in children later diagnosed with coeliac disease commonly starts at 12 months of age, and precedes clinical symptoms that usually bring the suspicion of diagnosis.

  • Growth
  • Coeliac disease
  • MoBa
  • Children

https://doi.org/10.1136/archdischild-2016-312304

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    Footnotes

    • Contributors CRK conceptualised and designed the study, performed the data analyses and wrote the initial manuscript. MCM contributed to the design of the study, assisted with the statistical analyses and interpretation of the data, and critically revised the manuscript. HS assisted with the statistical analyses and interpretation of the data, and critically revised the manuscript. KEAL contributed to interpretation of the data and critically revised the manuscript. KS is the principal investigator and contributed to the design of the study, assisted with the statistical analyses and interpretation of the data, and critically revised the manuscript. All authors approved the final manuscript.

    • Funding The Norwegian Mother and Child Cohort Study (MoBa) is supported by the Norwegian Ministry of Health and the Ministry of Education and Research, NIH/NIEHS (contract no. N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537-01 and grant no.2 UO1 NS 047537-06A1). This subproject within MoBa is supported by the Norwegian Research Council (grant no. 221909/F20). KS: Oak Foundation.

    • Competing interests None declared.

    • Patient consent This was a cohort study were only women who consented to participate (written informed consent) were recruited.

    • Ethics approval The current study was approved by the Regional Committee for Medical Research Ethics of South-East Norway.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement It is possible for everyone to apply for access to MoBa data. There are no additional unpublished data from the current study. Our data will be available for editor/reviewer upon request.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.