Growth in Celiac Disease: Impact on Physical and Compartmental Growth

Typical, atypical, silent, and latent clinical forms of celiac disease, an immune mediated enteropathy triggered by gluten intake, have been described in literature. In overt, atypical, and silent forms of the disease, intestinal villous atrophy is detected, whereas in the latent forms, with a normal villous architecture, the biochemical indexes of disease (i.e., anti-transglutaminase antibodies, tTG) are altered. Villous atrophy causes nutrient malabsorption, which can selectively affect either divalent cations, such as iron, or the entire spectrum of nutrients. Although celiac disease occurs in children in the majority of cases, and can have a significant impact on their overall growth, its frequency in adults has reportedly increased; in this age category, celiac disease mainly causes the selective malabsorption of nutrients, with consequent selective growth deficiencies, including iron deficiency anemia and osteoporosis. It is therefore of utmost importance at diagnosis, which is based on biochemical (tTG) and histological (duodenal histology with evidence of crypt hyperplasia and various degrees of villous atrophy) findings, to make an overall (weight and height) and selective (e.g., iron, calcium, and vitamins) evaluation of growth deficiencies. While follow-up for patients with uncomplicated celiac disease on a gluten-free diet does not call for a histological evaluation, it should include tTG to assess diet compliance and laboratory tests for nutritional status assessment (i.e., red blood cell count, iron, ferritin, calcium, and cholesterol).