Original articleAlimentary tractGrowth Trajectories and Bone Mineral Density in Anti-Tissue Transglutaminase Antibody–positive Children: The Generation R Study
Section snippets
Design
This study was embedded within a population-based prospective cohort study.13 All children were born between 2002 and 2006. From the age of 6 years, 6690 children visited the research center (median age, 6.0 years),13 of whom serum anti-tTG levels were available in 4442 (66%). Of these, we excluded twins, children with a questionnaire reported CD diagnosis and a GFD. The resulting population for analysis consisted of 4306 children (Supplementary Figure 1).
Anti-Tissue Transglutaminase Concentrations
Anti-tTG immunoglobulin A
Subject Characteristics
Mean child’s age was 6.2 years (range, 4.9–9.1). Of 4306 children, 57 (1.3%) had anti-tTG positive concentrations at 6 years of age, and 4249 (98.7%) had anti-tTG negative concentrations (Table 1, Supplementary Figure 1, Supplementary Table 1). Of children with anti-tTG positive concentrations, 91% carried the HLA-DQ2 or HLA-DQ8 molecule (Table 1). Higher income, female gender, and Western ethnicity were related to positive anti-tTG concentrations. Breastfeeding duration and timing of gluten
Discussion
This prospective observational study showed that anti-tTG positivity was associated with a deviation in height, weight, BMI, and BMD in young children. The effects of positive anti-tTG were mostly present in children with anti-tTG concentrations ≥10 times upper limit of normal (≥70 U/mL).
This is a population-based study that assessed associations between anti-tTG levels and growth longitudinally and BMD in anti-tTG positive children without gastrointestinal symptoms. Previous studies did not
Conclusion
Screening detected anti-tTG positive children have lower BMDs and reduced growth trajectories until they are 6 years old. This suggests that subclinical or potential CD can affect BMD and growth.
Acknowledgments
The Generation R Study is conducted by the Erasmus MC, Erasmus University Rotterdam in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam Metropolitan Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond. We gratefully acknowledge the contributions of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam.
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Conflicts of interest The authors disclose no conflicts.
Funding This phase of the Generation R Study was supported by the Erasmus MC, Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (ZonMw), and an unrestricted grant from NutsOhra (Grant number 1303-036).