Document Type : Original Article
Authors
1 Associate Professor, Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Ph.D., Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 Assistant Professor, Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
4 Professor, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Iran
5 Professor, Division of Endocrinology, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Introduction: Celiac disease results from the interaction of gluten, the immune system, and genetic and environmental factors, which is diagnosed via clinical symptomsincludingweight loss, steatorrhea, and malnutrition. It is usually presented in children who have malnutrition and failure to thrive, but it has been recently reported in some obese children. Since nowadays screening of high-risk/susceptible groups has been emphasized, this study aimed to evaluate the frequency of serologic celiac disease in obese children.
Methods: This cross-sectional study was conducted on 104obese children who referred to the Endocrine Clinic of Shiraz University of Medical Sciences, Shiraz, Iran in 2016. Data were collected using a questionnaire through face to face interviews. To measure Anti TTG IgA and total IgA Ab, 5 ml blood sample was taken. Data analysis was done using SPSS version 18.
Results: The mean age and BMI of the participants were 10.33±2.39 and 24.71±4.78, respectively, 65% of whom were girls. In this study, five patients (4.9%) had positive Anti TTG IgA, 80% of whom had reported positive gastrointestinal symptoms. The statistical tests suggested a positive and significant correlation between gastrointestinal symptoms and Anti TTG IgA.
Conclusion: Compared to 2% prevalence of serological TTG Anti in our community, a 5% prevalence Anti TTG IgA in obese children may indicate that there is an increased risk of potential celiac in obese children compared to the normal population. Therefore, it is recommended to screen obese children for celiac disease periodically and perform endoscopy and biopsy in the cases with persistence of anti-TTG.
Keywords
- Malekzadeh R, Shakeri R. Celiac disease in Iran. Tehran University Medical Journal. 2007; 64(2):1-11.
- Ciampolini M, Bini S. Serum Lipids in Celiac Children. Journal of Pediatric Gastroenterology and Nutrition. 1991; 12(4): 459–460.
- Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, Elli L, Grizzi F. Celiac disease: From pathophysiology to treatment. World journal of gastrointestinal pathophysiology. 2017;8(2):27.
- Fasano A. Clinical presentation of celiac disease in the pediatric population. Gastroenterology. 2005 Apr 1;128(4): S68-73.
- Honar N, Barkhordarian M, Ghanizadeh A, Radanfar R. Association of Celiac Disease with Attention Deficit Hyperactivity Disorder, J Compr Ped. Online ahead of Print. 2020; 11(1): e97114.
- Rossi TM, Albini CH, Kumar V. Incidence of celiac disease identified by the presence of serum endomysial antibodies in children with chronic diarrhea, short stature, or insulin-dependent diabetes mellitus. The Journal of Pediatrics. 1993; 123(2): 262–264. doi:10.1016/s0022-3476(05)81699-3
- Patwari AK, Anand VK, Kapur G, Narayan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr. 2003 Apr; 40(4):337-42.
- Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006;101(10):2356-2359.
- Bhatnagar S, Gupta SD, Mathur M, Phillips AD, Kumar R, Knutton S, Bhan MK. Celiac Disease with Mild to Moderate Histologic Changes is a Common Cause of Chronic Diarrhea in Indian Children. Journal of Pediatric Gastroenterology and Nutrition. 2005 41(2): 204–209. doi: 10.1097/01.mpg.0000172261.24115.29 Kk.
- Akbari MR, Mohammadkhani A, Fakheri H, Javad Zahedi M, Shahbazkhani B, Nouraie M, et al. Screening of the adult population in Iran for coeliac disease: comparison of the tissuetransglutaminase antibody and anti-endomysial antibody tests. Eur J Gastroenterol Hepatol. 2006; 18: 1181-6.
- Khoshnia M, Pourshams A, Mohammadkhani A, Tavangar SM, Shahbazkhani B, Malekzadeh R. Celiac Disease in Gonbad-Kavoos. Govaresh. 2005;10(3):131–4.
- Dehghani SM, Haghighat M, Mobayen A, Rezaianzadeh A, Geramizadeh B. Prevalence of celiac disease in healthy Iranian school children. Ann Saudi Med. 2013;33(2):159-61.
- Venkatasubramani N, Telega G, Werlin SL. Obesity in Pediatric Celiac Disease. Journal of Pediatric Gastroenterology and Nutrition. 2010; 1. doi: 10.1097/mpg.0b013e3181d1365a
- Capriate T, Francavilla R, Ferretti F, Castellaneta S, Ancinelli M, Diamanti A. Celiac disease screening among a large cohort of overweight/obese children. Eur J Clin Nutr. 2016; 70(2): 282-4.
- Oso O, Fraser NC. A boy with coeliac disease and obesity. Acta Paediatr. 2006; 95: 618–619.
- Ludvigsson JF, Brandt L, Montgomery SM. Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa. BMC Gastroenterology. 2009; 9(1). doi:10.1186/1471-230x-9-57.
- Nenna R, Mosca A, Mennini M, Papa RE, Petrarca L, Mercurio R, Vania A. Coeliac Disease Screening Among a Large Cohort of Overweight/Obese Children. Journal of Pediatric Gastroenterology and Nutrition. 2015; 60(3): 405–407.
- Telega G, Bennet TR, Werlin S. Emerging New Clinical Patterns in the Presentation of Celiac Disease. Archives of Pediatrics & Adolescent Medicine. 2008; 162(2): 164. doi:10.1001/archpediatrics.2007.38
- Hull CM, Liddle M, Hansen N, Meyer LJ, Schmidt L, Taylor T, et al. Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis. British Journal of Dermatology. 2008;159(1):120-4.
- Brow JR, Parker F, Weinstein WM, Rubin CE. The small intestinal mucosa in dermatitis herpetiformis: I. Severity and distribution of the small intestinal lesion and associated malabsorption. Gastroenterology. 1971;60(3):355-61.
- Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. The American journal of clinical nutrition. 2004;79(4):669-73.
- West J, Logan RF, Card TR, Smith C, Hubbard R. Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Alimentary pharmacology & therapeutics. 2004 Jul;20(1):73-9. doi: 10.1111/j.1365-2036.2004. 02008.x
- Magazzù G, De Luca F. Obesity in a child with untreated coeliac disease. Helvetica paediatrica acta. 1987;42(1):45-8.
- Lucille A, Semeraro MD, Kenneth W. Gryboski obesity in celiac sprue. J Clin Gastroenterol. 1986; 8:177-80.
- Czaja-Bulsa G, Garanty-Bogacka B, Syrenicz M, Gebala A. Obesity in an 18-year-old boy with untreated celiac disease. Journal of pediatric gastroenterology and nutrition. 2001;32(2):226.
)