Growth Monitoring Effective at Predicting Celiac Disease Early

Internal Medicine World Report, March 2015,

A study published online in JAMA Pediatrics reported celiac disease (CD) could be detected several years earlier through the implementation of a growth-monitoring program.

A study published online in JAMA Pediatrics reported celiac disease (CD) could be detected several years earlier through the implementation of a growth-monitoring program.

The researchers compared routine measurements (n=191,467) of 51,332 healthy Finnish children between 0 to 20 years (n=25,059 girls and n=26,273 boys) and height (n=1051) and weight (n=601) measurements of 177 children with CD (n=106 girls and n=71 boys) before their diagnosis. In addition, the authors noted children with CD were measured on average 9 times, versus 4 times among the group of healthy children.

To detect CD, the authors utilized 5 growth-screening parameters, which entailed a “height for age standard deviation score (HSDS), body mass index (BMI;) for age SDS (BMI SDS), HSDS distance from target height (TH) (TH formula = 0.791 × mean parental height SDS − 0.147 for girls and 0.886 × mean parental height SDS — 0.071 for boys), change in height SDS(ΔHSDS), and change in BMI SDS (ΔBMI SDS) across time with free age intervals.”

While recurrent abdominal pain and low hemoglobin levels were present in 27% and 31% CD-afflicted children, respectively, the 5-point screening program was highly accurate in detecting the condition (area under the curve [95% CI]=0.88 [0.84—0.93] for girls and 0.84 [0.77–0.91] for boys). When the test was specified by 90%, the program detected abnormal growth patterns in 57% of girls and 48% of boys 2 years prior to a formal CD diagnosis.

“The best growth screening accuracy can be obtained if childhood growth is monitored longitudinally rather than via one-off measurements and if the height and weight measurements are systematically evaluated using established screening parameters and contemporary cutoff values,” the investigators noted.

Since growth screening can be complex, the researchers recommended the regimen be used with the assistance of computerized screening algorithmsm, which are integrated into electronic health record (EHR) systems.