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


CONCLUSIONS
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.
van Dommelen
Paula
P
Dept. of Statistics, TNO Quality of life, Leiden, The Netherlands. paula.vandommelen@tno.nl
Grote
Floor K
FK
Oostdijk
Wilma
W
Keizer-Schrama
Sabine M P F de Muinck
SM
Boersma
Bart
B
Damen
Gerard M
GM
Csizmadia
Cassandra G
CG
Verkerk
Paul H
PH
Wit
Jan M
JM
van Buuren
Stef
S
D001827:Body Height / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity
Gut. 1997 Jan;40(1):61-6
9155577
J Pediatr Gastroenterol Nutr. 2007 Nov;45(5):611-4
18030243
Arch Dis Child. 2004 Apr;89(4):336-41
15033842
Ned Tijdschr Geneeskd. 1998 Nov 14;142(46):2519-25
10028341
Arch Dis Child. 1995 Jul;73(1):8-16
7639558
Stat Med. 1998 Dec 15;17(23):2697-707
9881416
Pediatr Res. 2000 Mar;47(3):316-23
10709729
Scand J Gastroenterol. 2005 Jan;40(1):15-9
15841709
J Pediatr Endocrinol Metab. 2005 Nov;18(11):1031-8
16459448
Arch Dis Child. 2004 Sep;89(9):882-3
15321874
Horm Res. 2002;58 Suppl 1:57-65
12373016
Acta Paediatr Scand. 1991 Aug-Sep;80(8-9):756-62
1957592
Arch Dis Child. 2008 Mar;93(3):212-7
17908714
J Pediatr. 2005 Aug;147(2):239-43
16126057
J Pediatr Gastroenterol Nutr. 1994 Nov;19(4):394-400
7876992
Am J Gastroenterol. 1999 Mar;94(3):691-6
10086653
Gastroenterology. 2005 Apr;128(4 Suppl 1):S68-73
15825129
Ann Hum Biol. 1994 Sep-Oct;21(5):449-63
7985994
Postgrad Med J. 2006 Nov;82(973):705-12
17099088
Hum Mutat. 2002 Jun;19(6):575-606
12007216
Lancet. 1999 Mar 6;353(9155):813-4
10459972
Arch Dis Child. 2000 Feb;82(2):107-12
10648362