Gluten for punishment

One in 100 UK kids show signs of celiac disease.
It makes them shorter and lighter

By Owen Dyer

Celiac disease is a hereditary condition, but because it's widely believed to manifest itself clinically only in adulthood, doctors almost never look for it in children. Research in the February 7 issue of the British Medical Journal, however, suggests that the effects of celiac disease can make themselves felt even before puberty.

Among adults, many of those who test positive for antibodies to celiac disease show no symptoms, especially if they follow gluten-free diets. But many of them are of shorter than average stature and show mild deformities of the long bones. This led British researchers to suspect that ignoring possible celiac disease in childhood may not be a harmless oversight.

The Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort study established in 1990, provided the researchers with an ideal study population of no less than 5,470 seven-year-old children of both sexes. Moreover, questionnaires completed just before the children's seventh birthdays provided details of any special diets or gastrointestinal symptoms.

According to the researchers, the incidence of celiac disease among British adults is about one in 100, although most of these patients do not have clinically significant symptoms. Among British children, only one in 2,500 is receiving treatment for celiac disease.

Dr Polly Bingley and others from the University of Bristol and Bristol's Southmead Hospital analyzed blood samples collected from the seven-year-old test subjects, looking for antibodies to tissue transglutaminase and IgA enomysial antibodies (IgA-EmA), which are markers for the disease. Fifty-four of them (1%) tested positive. Yet only four children were on a gluten-free diet.

This raises the possibility that children who have celiac disease but are not following gluten-free diets may already be at risk of damage to the intestinal tract. In a general population study published last year in the New England Journal of Medicine, 83% of patients who carried the same antibodies as those tested for in this research showed histological changes in the intestine upon biopsy.

The children with probable celiac disease were more than twice as likely to report multiple gastrointestinal symptoms such as diarrhea, vomiting, stomach pains and constipation.

But the most striking observation was that children who tested positive for IgA-EmA were shorter by 2.7cm (0.76 standard deviation scores) and lighter by 1kg (0.54 standard deviation scores) than antibody-negative children matched for date and place of birth. This equates to about nine months' growth and weight gain in an average child of seven.

The authors comment: "Occult celiac disease seems to start in childhood, even in those who are subsequently diagnosed as adults. The search for the trigger resulting in the breakdown of immune tolerance to gluten therefore needs to focus on infancy and intrauterine life."

It's unclear how the British results will translate to Canada. Most specialists believe the overall frequency of celiac disease is lower in North America. In fact, the highest concentrations of celiac disease are to be found in Southwestern Ireland, and the ethnic origins of this inherited disease are likely

to be Celtic or even Viking. This suggests that provinces like Newfoundland with a significant Irish genetic heritage are more likely to reproduce the British findings.