Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in São Paulo, Brazil.
BACKGROUND
To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD.


METHODS
Thirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten-free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x-ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained.


RESULTS
The mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 +/- 10.5 kg v 55.3 +/- 10.5 kg, P = 0.037; height: 153.0 +/- 11.0 cm v 167 +/- 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 +/- 0.116 g/cm2 v 1.060 +/- 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple-regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten-free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal.


CONCLUSIONS
The BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.
Division of Pediatric Gastroenterology, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
Vera Lucia
VL
Sdepanian
Cecília Noronha
CN
de Miranda Carvalho
Mauro Batista
MB
de Morais
Fernando Antonio Basile
FA
Colugnati
Ulysses
U
Fagundes-Neto
D000293:Adolescent; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D015519:Bone Density; D001938:Brazil; D002136:Calcium, Dietary / Q000008:administration & dosage; D002446:Celiac Disease / Q000178:diet therapy* / Q000503:physiopathology*; D002648:Child; D004032:Diet; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D008159:Lumbar Vertebrae; D008274:Magnesium / Q000008:administration & dosage; D016226:Phosphorus, Dietary / Q000008:administration & dosage; D012044:Regression Analysis
D002136:Calcium, Dietary; D016226:Phosphorus, Dietary; D005983:Glutens; D008274:Magnesium