Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades

Abstract

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders

“…Most studies in the literature have shown that CD patients (at diagnosis) have a lower BMI than the general population [10][11][12]; therefore, weight gain from a GFD may have positive effects on these patients. However, it has been clearly demonstrated that nowadays, an increasing number of CD patients present with a normal or high BMI at the time of diagnosis [3][4][5][6][7][8][9].…”

“…Historically, at the time of diagnosis, patents with CD had a reduced body mass index (BMI) compared to the general population [3]. In the last few decades, increasing numbers of CD patients with a normal or high BMI at the time of diagnosis was reported [4][5][6][7][8][9]. This could be due to the fact that early diagnosis has become more frequent in recent years (late diagnoses were more common in the past), allowing for a reduction in the rate of both intestinal mucosal atrophy and related malabsorption [9].…”

“…It has been observed that the nutritional status of patients who have received a diagnosis of CD in the last few years is better than that of those diagnosed in previous years. In one study, out of 155 patients diagnosed with CD between 1994 and 2017, patients who were overweight at diagnosis were observed only after 2002, and obesity was observed only after 2010 [9].…”

Multidimensional Disadvantages of a Gluten-Free Diet in Celiac Disease: A Narrative Review

“…Moreover, the nutritional status of the general population is of utmost importance for the correct interpretation of BMI in children at the time of the diagnosis of CD. It is vital to bear in mind that celiac disease can develop in overweight/obese patients, reflecting the individual predispositions (i.e., genetic, nutritional and environmental factors) [ 66 , 67 ]. Furthermore, the worldwide prevalence of overweight and obesity in children has increased over the past two decades; in fact, it is estimated that 60 million children will have been overweight or obese by 2020 [ 68 ].…”

It Is High Time for Personalized Dietary Counseling in Celiac Disease: A Systematic Review and Meta-Analysis on Body Composition

“…Formerly, classical CD with malnutrition due to intestinal malabsorption was the most prevalent [ 5 ]. Recently, the proportion of non-classical and asymptomatic CD patients with normal or high body weight (BW) already at the time of the diagnosis has been increasing rapidly, which can be attributed, among other things, to increasing disease awareness and accurate and accessible serological testing [ 6 , 7 , 8 ].…”