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Original research
Growth rate of coeliac children is compromised before the onset of the disease
  1. Renata Auricchio1,
  2. Pio Stellato1,
  3. Dario Bruzzese2,
  4. Donatella Cielo1,
  5. Alfredo Chiurazzi1,
  6. Martina Galatola1,
  7. Gemma Castilljeo3,
  8. Paula Crespo Escobar4,
  9. Judith Gyimesi5,
  10. Corina Hartman6,
  11. Sanja Kolacek7,
  12. Sybille Koletzko8,
  13. Ilma Korponay-Szabo5,
  14. Maria Luisa Mearin9,
  15. Caroline Meijer10,
  16. Malgoscia Pieścik-Lech10,
  17. Isabel Polanco11,
  18. Carmen Ribes-Koninckx12,
  19. Raanan Shamir13,14,
  20. Hania Szajewska15,
  21. Riccardo Troncone1,
  22. Luigi Greco1
  1. 1 Department of Translational Medical Science, University of Naples Federico II, Napoli, Italy
  2. 2 Department of Public Health, Federico II University, Naples, Italy
  3. 3 Hospital Universitari Sant Joan de Reus, Reus, Spain
  4. 4 Department of Health Science, European University Miguel de Cervantes, Valladolid, Spain
  5. 5 Heim Pál Children's, Budapest, Hungary
  6. 6 Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Tel Aviv, Israel
  7. 7 Referral Center for Pediatric Gastroenterology and Nutrition, Zagreb University, Medical School, Zagreb, Croatia
  8. 8 Department of Pediatric Gastroenterology and Hepatology, Ludwig Maximilian's University Munich Medical Center, Munich, Germany
  9. 9 Leiden University Medical Center, Leiden, The Netherlands
  10. 10 Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
  11. 11 Department of Pediatric Gastroenterology and Nutrition, La Paz University Hospital, Madrid, Spain
  12. 12 Paediatric Gastroenterology, La Fe University Hospital, Valencia, Spain
  13. 13 Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
  14. 14 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  15. 15 Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
  1. Correspondence to Dr Donatella Cielo, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; dona_cielo{at}yahoo.it

Abstract

Introduction Growth impairment has often been described in children who develop coeliac disease (CD). Based on data from the multicentre, longitudinal PreventCD study, we analysed the growth patterns of infants at genetic risk of CD, comparing those who developed CD by 6 years of age (CD ‘cases’, 113 infants) versus those who did not develop CD by 6 years (no CD ‘controls’, 831 infants).

Methods Weight and length/height were measured using a longitudinal protocol. Raw measurements were standardised, computing z-scores for length/height and weight; a linear mixed model was fitted to the data in order to compare the rate of growth in the two cohorts.

Results Neither cases nor controls had significant growth failure. However, when the mean z-scores for weight and height were analysed, there was a difference between the two groups starting at fourth month of life. When the growth pattern in the first year was analysed longitudinally using mixed models, it emerged that children who develop CD had a significantly lower growth rate in weight z-score (−0.028/month; 95% CI −0.038 to −0.017; p<0.001) and in length/height z-score (−0.018/month; 95% CI −0.031 to −0.005; p=0.008) than those who do not develop CD. When the whole follow-up period was analysed (0–6 years), differences between groups in both weight and length/height z-scores were confirmed.

Conclusion The growth of children at risk of CD rarely fell below ‘clinical standards’. However, growth rate was significantly lower in cases than in controls. Our data suggest that peculiar pathways of growth are present in children who develop CD, long before any clinical or serological signs of the disease appear.

  • gastroenterology
  • growth
  • paediatric practice

https://doi.org/10.1136/archdischild-2019-317976

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    Footnotes

    • Correction notice This article has been updated since it was published online. The fourth author's affiliation was missing and this has now been added.

    • Funding This work was funded by the PreventCD Project (EU-FP6-2005-FOOD4B-contract no. 036383).

    • Disclaimer The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the medical ethics committees of the participating centres.

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data available through ydongre@unina.it.