Three reports on celiac disease:
- KM Simmons et al. J Pediatr 2016; 169: 44-8.
- NR Reilly et al. J Pediatr 2016; 169: 40-54
- MMS Wessels et al. J Pediatr 2016; 169: 55-60.
In the first study, the authors examined bone mineral density (BMD), glycemic control with hemoglobin A1c, and celiac autoimmunity in children with type 1 diabetes (T1D). This was a cross-sectional study of 252 children with T1D; 123 had positive serology were anti-tissue transglutaminase (tTG) antibody. In addition, another cohort (n=141) of children without T1D were examined who carried HLD-DR, DQ genotypes with (n=71) and without (n=70) tTG. Key findings:
- Children with T1D: those positive for tTG had significantly worse BMD L1-L4 (-0.45 ± 1.22 vs 0.09 ± 1.10, P= .0003). Higher tTG and higher HgbA1c were independent predictors of lower BMI.
- In children without T1D: no differences in BMD were found based on tTG status.
- The authors concluded that celiac autoimmunity and hyperglycemia had synergistic effects on low BMD.
In the second study, the researchers used a population-based cohort study and compared 958 individuals with both T1D and celiac disease (CD) to 4598 similar individuals with T1D alone. Key finding: Over a 13 year period, 12 patients with both T1D and CD had a fracture (1 osteoporotic fracture). CD did not influence the risk of any fracture (aHR 0.77) in patients with T1D. The researches concluded: “CD does not seem to influence fracture risk in young patients with T1D.”
My take: Looking at these studies in juxtaposition shows how important it is to consider multiple studies and how frequent discrepant results occur. While the second study does not show a significant fracture risk, the preponderance of evidence does show an association between celiac disease and low BMD particularly in adults. In addition, a gluten free diet has been shown to reverse low BMD in those with CD.
- Gastroenterology 2010; 139: 763.
- Aliment Pharmacol Ther 2000; 14: 35-43.
- JPGN 2003; 37: 434-6.
- Gut 1996; 38: 322-7.
In the third study, the investigators looked at “complementary” investigation in children with CD. These included tests like hemoglobin, ferritin, folate, vitamin B12, calcium, vitamin D, and thyroid assays. Between 2009-2014, 182 children were evaluated included 119 with new diagnosis. Key findings:
- At time of diagnosis: Iron deficiency (28%), iron deficiency anemia (9%), folate deficiency (14%), vitamin B12 (1%), and vitamin D deficiency (27%) were identified. No hypocalcemia or thyroid dysfunction was found.
- At followup: iron deficiency (8%), iron deficiency anemia (2%), folate (3%), vitamin D (25%) were identified and no other abnormalities were evident.
- The investigators concluded that these complementary tests “are relevant at the time of diagnosis of CD but have little diagnostic yield during followup-visits” after institution of gluten-free diet.
My take: Particularly at followup, identification of nutrient deficiencies is typically similar to the general population.
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