Systematic growth monitoring for the early detection of celiac disease in children.
OBJECTIVE
Growth-monitoring programs in children aim to achieve the early detection of disorders that affect growth. Celiac disease (CD) is underdiagnosed in the pediatric population in which the presenting features often include faltering linear growth, short stature, or poor weight gain.


OBJECTIVE
To develop new evidence-based cutoffs for screening for growth disorders and to evaluate the performance of these cutoffs among children with CD measured regularly in a nationwide growth screening program.


METHODS
A longitudinal retrospective study that included longitudinal growth data of healthy children (the reference population) from primary health care and children with CD (the cases) from primary health care and 3 university hospital outpatient clinics in Finland (Kuopio University Hospital, Tampere University Hospital, and Helsinki University Hospital) from January 1, 1994, to April 9, 2009. Children of the reference population were between 0 and 20 years of age and children with CD were between 1 and 16 years of age. In the reference population of 51,332 healthy children, 5 age-specific and sex-specific growth-screening parameters (height standard deviation score and body mass index standard deviation score distance from the population mean, distance from target height, change in height standard deviation score, and change in body mass index standard deviation score) were developed. Performance of these parameters and their combination was evaluated in 177 children with CD by analyzing longitudinal growth data from birth until diagnosis of CD.


METHODS
The screening accuracy for detecting abnormal growth in children with CD, assessed using receiver operating characteristics analysis expressed as the area under the curve.


RESULTS
Celiac disease was detected with good accuracy (area under the curve [95% CI] = 0.88 [0.84-0.93] for girls and 0.84 [0.77-0.91] for boys) when screening was performed using the combination of all 5 growth-screening parameters. When the specificity of the screening was set at 90%, growth was already abnormal in 57% of the girls with CD and 48% of the boys with CD 2 years prior to diagnosis.


CONCLUSIONS
Prior to diagnosis, growth faltered in most children with CD. These children could have been detected several years earlier by a well-established growth-monitoring program. Acceptable screening accuracy can be achieved for CD via the use of several growth-monitoring parameters in combination, preferably using computerized screening algorithms that are integrated into an electronic health record system.
Department of Pediatrics, School of Medicine, University of Eastern Finland, Kuopio.
Antti
A
Saari
Department of Pediatrics, School of Medicine, University of Eastern Finland, Kuopio.
Samuli
S
Harju
Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland3Folkhälsan Research Centre, Helsinki, Finland4Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Outi
O
Mäkitie
Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
Marja-Terttu
MT
Saha
Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England.
Leo
L
Dunkel
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Ulla
U
Sankilampi
D000293:Adolescent; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D005387:Finland; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity