Dedicated to Dr. Guido Fanconi on the occasion of his 80th birthday Catch-up Growth in Malnutrition, Studied in Celiac Disease After Institution of Gluten-free Diet

Abstract

ExtractCeliac disease provides a model for investigation of one form of infantile malnutrition occurring under fully controlled circumstances. Thirteen patients aged 9-15 months were followed for a period of at least 3 years while they were on a strict gluten-free diet.Observed values for height, weight, bone age, metacarpal diameter, and cortical thickness are compared with the normal range based on local standards, and the results are expressed as standard scores. The mean curves of these data are presented in Figures 1 and 2. At the time of diagnosis and the beginning of diet (zero time), all variables were retarded, and standard scores were significantly below normal in height (P < 0.01), weight (P < 0.001), bone age (P < 0.01), metacarpal cortex (P < 0.05), and diameter (P < 0.001). Weight was significantly more depressed than height (P < 0.01), bone age (P < 0.001), metacarpal cortex (P < 0.001), and diameter (P < 0.001). Height was significantly more depressed than bone age (P < 0.05). As the patients recovered, weight caught up faster than the other measurements; weight was not significantly below normal after the patients had been on a gluten-free diet for 6 months and it reached normal values between 6 months and 1 year after initiation of diet. Height and bone age did not reach normal levels until after 2 years of treatment, although the values were no longer significantly depressed after 1 year on the diet. Cortical thickness was no longer significantly depressed after 6 months on the diet; it reached normal values by 6 months to 1 year after initiation of diet, and then showed an overshooting type of catch-up with values remaining significantly elevated at 2 years (P < 0.05) and 3 years (P < 0.05) after the onset of diet. Metacarpal diameter showed a slow steady catch-up growth which remained below normal throughout the follow-up period although the values were no longer significantly below normal 3 years after patients had begun diet.The study provides evidence that children aged 1 year (±3 months) who suffer from malnutrition caused by celiac disease catch up completely in weight, height, bone age, and metacarpal cortical thickness during a dietary treatment period of 3 years. SpeculationPoor physical growth resulting from this type and this degree of malnutrition in the second half of the 1st year of life is completely remediable. Permanent somatic sequelae from a similar severity of late infantile malnutrition in underdeveloped countries, therefore, might not be inevitable, provided that the therapeutic program is optimal and adverse factors do not continue to operate.

Catch-Up Growth and Endocrine Changes in Childhood Celiac Disease

“…Withdrawal of gluten from the diet constitutes removal of the pathogenetic factor and is an effective treatment for CCD. After institution of a gluten-free diet, the symptoms usually disappear quite rapidly and most patients exhibit complete catch-up growth [5, 6, 7]. These characteristics render CCD an elegant human model for the study of catch-up growth.…”

Body mass index in celiac disease and effect of a gluten-free diet on body mass index

“…Nutritional rehabilitation leads to growth acceleration in most CD patients. [8][9][10] GFD heals in fact the intestinal mucosa and corrects malabsorption, with a more rapid recovery of fat mass. 11,12 Results of our study was similar with a study by Cheng et al, which also showed a positive effect of a GFD by demonstrating weight gain in previously underweight patients and weight loss in those previously overweight.…”

Avaliação nutricional e consumo alimentar de pacientes com doença celíaca com e sem transgressão alimentar

“…Esse fato pode ser explicado pelas próprias transgressões alimentares, que causam comprometimento da estatura nos indivíduos. Para a recuperação de deficit de estatura, é necessário um período maior do que o necessário para a normalização de peso: 2 a 3 anos, em média, contra 10 a 12 meses após o início do tratamento dietético, respectivamente 38,40,41 . No critério de inclusão deste estudo, definiu-se que o diagnóstico de doença celíaca e a prescrição de dieta sem glúten tivessem sido realizados há pelo menos um ano, com a expectativa de que esse período fosse suficiente para a completa recuperação ponderal e, ao menos, recuperação parcial de estatura.…”