Seropositivity to celiac antigens in asymptomatic children with type 1 diabetes mellitus: association with weight, height, and bone mineralization.

Published

Journal Article

BACKGROUND: Screening for celiac disease (CD) in children with diabetes is controversial because no studies have demonstrated metabolic complications in asymptomatic, seropositive subjects or beneficial effects of dietary intervention. OBJECTIVE: We hypothesized that seropositivity to celiac antigens is associated with decreased growth and bone mineralization in asymptomatic diabetic children. DESIGN/METHODS: Asymptomatic diabetic children were screened for seropositivity to tissue transglutaminase. Villous atrophy was assessed by small bowel biopsy in a subset of seropositive subjects. We compared measures of growth and bone mineralization in 30 seropositive subjects, and 34 matched seronegative controls. RESULTS: Relative to seronegative controls, the seropositive subjects had reductions in insulin-like growth factor (IGF) binding protein 3 z scores (p < 0.05) and bone mineral density (BMD) z scores (p = 0.05). Weight, body mass index, IGF-I, and bone mineral apparent density (BMAD) z scores were marginally lower, but height z scores were comparable. Seropositive patients with severe villous atrophy had lower weight (-0.91 SDs), height (-1.1 SDs), BMD (-2.0 SDs), and BMAD (-2.0 SDs) z scores and significant increases in parathyroid hormone (all p < 0.05). Four patients with severe villous atrophy maintained strict gluten restriction for at least 12 months. Gluten restriction increased BMD and BMAD z scores. CONCLUSIONS: High-titer seropositivity to celiac antigens is associated with reductions in weight and BMD in diabetic children, justifying screening of high-risk patients. Results suggest that biopsy is required to confirm the diagnosis and assess the severity of CD; those with severe villous atrophy are more likely to have growth failure and osteopenia. Gluten restriction may reverse these complications.

Full Text

Duke Authors

Cited Authors

  • Artz, E; Warren-Ulanch, J; Becker, D; Greenspan, S; Freemark, M

Published Date

  • July 28, 2008

Published In

Volume / Issue

  • 9 / 4 Pt 1

Start / End Page

  • 277 - 284

PubMed ID

  • 18466211

Pubmed Central ID

  • 18466211

Electronic International Standard Serial Number (EISSN)

  • 1399-5448

Digital Object Identifier (DOI)

  • 10.1111/j.1399-5448.2008.00386.x

Language

  • eng

Conference Location

  • Denmark