title: Factors associated with growth disturbance at celiac disease diagnosis in children: a retrospective cohort study.
abstract: BACKGROUND
  Impaired growth is a well-known complication in celiac disease, but factors associated with it are poorly known. We investigated this issue in a large cohort of children.
  
  
  METHODS
  530 children with biopsy-proven celiac disease were included. The participants were divided into two groups on the basis of the presence (n = 182) or absence (n = 348) of growth disturbance at diagnosis. Histological, serological and clinical characteristics were compared between children with growth failure and those with normal growth. Further, patients with growth failure as the sole clinical presentation were compared to those with poor growth and concomitant other symptoms.
  
  
  RESULTS
  Children with growth failure were younger (p < 0.001) and had lower hemoglobin (p = 0.016) and higher celiac antibody (p < 0.001), alanine aminotransferase (p = 0.035) and thyroid-stimulating hormone values (p = 0.013) than those with normal growth. Significantly associated with growth failure at diagnosis were age <3 years (OR 4.3 (95 % CI 2.5-7.5) vs older age), diagnosis before the year 2000 and in 2000-09 (OR 3.1 (1.8-5.4) and OR 1.8 (1.1-2.8) vs diagnosis in 2010-2013), presence of total and subtotal villous atrophy (OR 4.2 (2.5-7.0) and OR 2.0 (1.3-3.2) vs partial atrophy), severe symptoms (OR 3.4 (1.8-6.7) vs mild symptoms) and vomiting (OR 3.1 (1.5-6.3). The presence of abdominal pain reduced the risk (OR 0.5 (0.3-0.7)), while there was no effect of gender, diarrhea, constipation, other chronic diseases and celiac disease in the family. Children evincing poor growth as the sole clinical presentation were older (p < 0.001) and had higher hemoglobin (P < 0.001) and total iron (p = 0.010) values and lower TG2ab values (p = 0.009) than those with growth disturbance and other symptoms.
  
  
  CONCLUSIONS
  In particular young age and severe clinical and histological presentation were associated with growth disturbance at celiac disease diagnosis. Children with only poor growth are markedly different from those with other concomitant symptoms, suggesting different pathogenic mechanisms.
authors.affiliation: School of Medicine, University of Tampere, FIN-33014, Tampere, Finland. nurminen.samuli.j@student.uta.fi.|Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. nurminen.samuli.j@student.uta.fi.
authors.forename: Samuli
authors.initials: S
authors.lastname: Nurminen
authors.affiliation: School of Medicine, University of Tampere, FIN-33014, Tampere, Finland. laura.kivela@fimnet.fi.|Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. laura.kivela@fimnet.fi.
authors.forename: Laura
authors.initials: L
authors.lastname: Kivelä
authors.affiliation: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. juha.taavela@uta.fi.
authors.forename: Juha
authors.initials: J
authors.lastname: Taavela
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland. heini.huhtala@staff.uta.fi.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. markku.maki@uta.fi.
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.affiliation: School of Medicine, University of Tampere, FIN-33014, Tampere, Finland. katri.kaukinen@uta.fi.|Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. katri.kaukinen@uta.fi.
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.affiliation: School of Medicine, University of Tampere, FIN-33014, Tampere, Finland. kalle.kurppa@uta.fi.|Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. kalle.kurppa@uta.fi.
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
mesh_terms: D015746:Abdominal Pain / Q000150:complications; D000367:Age Factors; D017668:Age of Onset; D000409:Alanine / Q000097:blood; D000906:Antibodies / Q000097:blood; D001284:Atrophy / Q000473:pathology; D002446:Celiac Disease / Q000097:blood / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005183:Failure to Thrive / Q000097:blood / Q000209:etiology*; D005260:Female; D019204:GTP-Binding Proteins / Q000097:blood; D006130:Growth Disorders / Q000097:blood / Q000209:etiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007422:Intestines / Q000473:pathology; D007501:Iron / Q000097:blood; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D012307:Risk Factors; D013972:Thyrotropin / Q000097:blood; D000637:Transaminases / Q000097:blood; D011503:Transglutaminases / Q000097:blood
chemical_list: D000906:Antibodies; D006454:Hemoglobins; D013972:Thyrotropin; D007501:Iron; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D000637:Transaminases; D019204:GTP-Binding Proteins; D000409:Alanine