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Screening rules for growth to detect celiac disease: a case-control simulation study.

van Dommelen P, Grote FK, Oostdijk W, Keizer-Schrama SM, Boersma B, Damen GM, Csizmadia CG, Verkerk PH, Wit JM, van Buuren S - BMC Pediatr (2008)

Bottom Line: The growth criteria did not discriminate between the screened CD group and the reference group.For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS.BMI is a better predictor than weight, and much better than length or height.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept. of Statistics, TNO Quality of life, Leiden, The Netherlands. paula.vandommelen@tno.nl

ABSTRACT

Background: It is generally assumed that most patients with celiac disease (CD) have a slowed growth in terms of length (or height) and weight. However, the effectiveness of slowed growth as a tool for identifying children with CD is unknown. Our aim is to study the diagnostic efficiency of several growth criteria used to detect CD children.

Methods: A case-control simulation study was carried out. Longitudinal length and weight measurements from birth to 2.5 years of age were used from three groups of CD patients (n = 134) (one group diagnosed by screening, two groups with clinical manifestations), and a reference group obtained from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort (n = 2,151) in The Netherlands. The main outcome measures were sensitivity, specificity and positive predictive value (PPV) for each criterion.

Results: Body mass index (BMI) performed best for the groups with clinical manifestations. Thirty percent of the CD children with clinical manifestations and two percent of the reference children had a BMI Standard Deviation Score (SDS) less than -1.5 and a decrease in BMI SDS of at least -2.5 (PPV = 0.85%). The growth criteria did not discriminate between the screened CD group and the reference group.

Conclusion: For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS. BMI is a better predictor than weight, and much better than length or height. Toddlers with CD detected by screening grow normally at this stage of the disease.

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Related in: MedlinePlus

Flow chart of children with CD used in the study.
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Figure 1: Flow chart of children with CD used in the study.

Mentions: Longitudinal length and weight data of patients with CD were collected from three different studies. The first study was a prospective screening study using blood tests in unrecognized CD in children aged 2–4 years, visiting the Community Child Health Care Centers in the Dutch province of Zuid (South)-Holland [9]. In this study, 32 children with CD were detected between May 1997 and June 1998. The second study was a retrospective study on catch up growth in patients with CD [13]. A written questionnaire including their symptomatology, duration of complaints before diagnosis, age at diagnosis, associated diseases in the past and parental heights was sent to all members of the Dutch Celiac Society in the early nineteen eighties. Growth data were collected from 74 children younger than 16 years. The third study was a prospective study on catch up growth [14]. All newly diagnosed childhood CD patients from two separate pediatric departments were included between April 1994 and September 1995 (n = 28). The children in the second and third study presented with a full range of classical symptoms. We used all growth data before and at the start of the gluten-free diet, till the age of 2.5 years. The data was gathered retrospectively from child welfare clinics, pediatricians and general practitioners. Additional growth information of these children was obtained from physicians in the Regional Child Health Care Centres. The diagnosis of CD was confirmed by histology for all patients, although in the retrospective study we were dependent on the information provided by patient reports. In total, we included 134 children: 32 children from the first study, 74 children from the second study and 28 children from the third study. Exclusion criteria were: an unknown date of starting the gluten-free diet and no measurement between birth and 2.5 years of age. After excluding such cases, 122 children were eligible for further analyses: 26 children from the first study and 96 children from the second and third study (see Figure 1).


Screening rules for growth to detect celiac disease: a case-control simulation study.

van Dommelen P, Grote FK, Oostdijk W, Keizer-Schrama SM, Boersma B, Damen GM, Csizmadia CG, Verkerk PH, Wit JM, van Buuren S - BMC Pediatr (2008)

Flow chart of children with CD used in the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2551593&req=5

Figure 1: Flow chart of children with CD used in the study.
Mentions: Longitudinal length and weight data of patients with CD were collected from three different studies. The first study was a prospective screening study using blood tests in unrecognized CD in children aged 2–4 years, visiting the Community Child Health Care Centers in the Dutch province of Zuid (South)-Holland [9]. In this study, 32 children with CD were detected between May 1997 and June 1998. The second study was a retrospective study on catch up growth in patients with CD [13]. A written questionnaire including their symptomatology, duration of complaints before diagnosis, age at diagnosis, associated diseases in the past and parental heights was sent to all members of the Dutch Celiac Society in the early nineteen eighties. Growth data were collected from 74 children younger than 16 years. The third study was a prospective study on catch up growth [14]. All newly diagnosed childhood CD patients from two separate pediatric departments were included between April 1994 and September 1995 (n = 28). The children in the second and third study presented with a full range of classical symptoms. We used all growth data before and at the start of the gluten-free diet, till the age of 2.5 years. The data was gathered retrospectively from child welfare clinics, pediatricians and general practitioners. Additional growth information of these children was obtained from physicians in the Regional Child Health Care Centres. The diagnosis of CD was confirmed by histology for all patients, although in the retrospective study we were dependent on the information provided by patient reports. In total, we included 134 children: 32 children from the first study, 74 children from the second study and 28 children from the third study. Exclusion criteria were: an unknown date of starting the gluten-free diet and no measurement between birth and 2.5 years of age. After excluding such cases, 122 children were eligible for further analyses: 26 children from the first study and 96 children from the second and third study (see Figure 1).

Bottom Line: The growth criteria did not discriminate between the screened CD group and the reference group.For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS.BMI is a better predictor than weight, and much better than length or height.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept. of Statistics, TNO Quality of life, Leiden, The Netherlands. paula.vandommelen@tno.nl

ABSTRACT

Background: It is generally assumed that most patients with celiac disease (CD) have a slowed growth in terms of length (or height) and weight. However, the effectiveness of slowed growth as a tool for identifying children with CD is unknown. Our aim is to study the diagnostic efficiency of several growth criteria used to detect CD children.

Methods: A case-control simulation study was carried out. Longitudinal length and weight measurements from birth to 2.5 years of age were used from three groups of CD patients (n = 134) (one group diagnosed by screening, two groups with clinical manifestations), and a reference group obtained from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort (n = 2,151) in The Netherlands. The main outcome measures were sensitivity, specificity and positive predictive value (PPV) for each criterion.

Results: Body mass index (BMI) performed best for the groups with clinical manifestations. Thirty percent of the CD children with clinical manifestations and two percent of the reference children had a BMI Standard Deviation Score (SDS) less than -1.5 and a decrease in BMI SDS of at least -2.5 (PPV = 0.85%). The growth criteria did not discriminate between the screened CD group and the reference group.

Conclusion: For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS. BMI is a better predictor than weight, and much better than length or height. Toddlers with CD detected by screening grow normally at this stage of the disease.

Show MeSH
Related in: MedlinePlus