Seropositivity to celiac antigens in asymptomatic children with type 1 diabetes mellitus: association with weight, height, and bone mineralization.
BACKGROUND
Screening for celiac disease (CD) in children with diabetes is controversial because no studies have demonstrated metabolic complications in asymptomatic, seropositive subjects or beneficial effects of dietary intervention.


OBJECTIVE
We hypothesized that seropositivity to celiac antigens is associated with decreased growth and bone mineralization in asymptomatic diabetic children.


METHODS
Asymptomatic diabetic children were screened for seropositivity to tissue transglutaminase. Villous atrophy was assessed by small bowel biopsy in a subset of seropositive subjects. We compared measures of growth and bone mineralization in 30 seropositive subjects, and 34 matched seronegative controls.


RESULTS
Relative to seronegative controls, the seropositive subjects had reductions in insulin-like growth factor (IGF) binding protein 3 z scores (p < 0.05) and bone mineral density (BMD) z scores (p = 0.05). Weight, body mass index, IGF-I, and bone mineral apparent density (BMAD) z scores were marginally lower, but height z scores were comparable. Seropositive patients with severe villous atrophy had lower weight (-0.91 SDs), height (-1.1 SDs), BMD (-2.0 SDs), and BMAD (-2.0 SDs) z scores and significant increases in parathyroid hormone (all p < 0.05). Four patients with severe villous atrophy maintained strict gluten restriction for at least 12 months. Gluten restriction increased BMD and BMAD z scores.


CONCLUSIONS
High-titer seropositivity to celiac antigens is associated with reductions in weight and BMD in diabetic children, justifying screening of high-risk patients. Results suggest that biopsy is required to confirm the diagnosis and assess the severity of CD; those with severe villous atrophy are more likely to have growth failure and osteopenia. Gluten restriction may reverse these complications.
Artz
Evelyn
E
Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA. artz0001@mc.duke.edu
Warren-Ulanch
Julia
J
Becker
Dorothy
D
Greenspan
Susan
S
Freemark
Michael
M
D001707:Biopsy, Needle; D001827:Body Height; D001835:Body Weight; D002113:Calcification, Physiologic; D002446:Celiac Disease / Q000150:complications / Q000276:immunology* / Q000473:pathology*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology*; D005260:Female; D019204:GTP-Binding Proteins; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008403:Mass Screening; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology
D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins