doiSerbia

Effect of gluten-free diet on the growth and nutritional status of children with coeliac disease

Radlović Nedeljko (Univerzitetska dečja klinika, Beograd)
Mladenović Marija (Zdravstveni centar, Valjevo)
Leković Zoran (Univerzitetska dečja klinika, Beograd)
Živanović Dragana (Univerzitetska dečja klinika, Beograd)
Brdar Radivoj (Univerzitetska dečja klinika, Beograd)
Radlović Vladimir (Univerzitetska dečja klinika, Beograd)
Ristić Dragana (Univerzitetska dečja klinika, Beograd)
Pavlović Momčilo (Opšta bolnica, Subotica)
Stojšić Zorica (Institut za patologiju, Medicinski fakultet, Beograd)
Vuletić Biljana (Pedijatrijska klinika, Klinički centar 'Kragujevac', Kragujevac)
Đurđević Jelena (Zavod za zaštitu radnika 'Železnica Srbije', Beograd)
Gajić Milan (Institut za medicinsku statistiku i informatiku, Medicinski fakultet, Beograd)

Introduction. Gluten-free diet (GFD) presents the basis of coeliac disease (CD) treatment. If strictly applied, the disorders of the small bowel mucosa and other disease signs rapidly resolve. Objective. The goal of the study was to evaluate the effect of GFD on the growth and nutritional status of children with the classical form of CD. In addition, we analyzed the differences between these parameters with the duration and the patients' compliance with GFD. Methods. The study goals were achieved on a sample of 90 children, 56 female and 34 male, aged 0.5-7.5 (1.53±1.05) years, with the classic CD diagnosed on the basis of typical pathohistological findings of the small bowel mucosa and clinical recovery of patients on GFD. The duration of the patients' follow-up was 1.08-8.75 (3.03±1.14) years, i.e. until the age of 2.5-15 (4.59±1.78) years. The initial and control values of body height (BH) in relation to matched values for age and gender were expressed in percentiles, while the deviation in body weight (BW) for the matched values of height and gender was expressed in percentages. The referent haemoglobin (Hb) rate in blood, as a laboratory indicator of nutritional status in children aged up to 5 years was ≥110 g/L, and for those aged above 5 years it was ≥115 g/L. Compliance with GFD was based on the pathohistological findings of the small bowel mucosa or determination of tissue transglutaminase. Results. Over the studied period, the effect of GFD was highly significant, both on the increase of BH percentiles (37.62±26.26 vs. 57.22±25.29; p<0.001), and on the decrease of BW deficit 11.58±10.80 vs. 0.89±8.194; p<0.001). After the treatment period, none of the children showed slowed growth rate or BW deficit above 20%, while BW deviation ranging between 10-20% in relation to the referent values was registered in 17 (18.19%) and the excess of over 20% in 2 patients. In 86 (95.56%) patients, control Hb values in blood were normal, while mild anaemia was registered in 4 patients, all compliant with GFD. The difference between the compliant and non-compliant patients with GFD was not detected either in BH percentiles (p=0.586) or in BW percentage deviation as compared to standard values (p=0.516) or in blood Hb values (p=0.445). In addition, differences between the children on GFD lasting over and below 3 years were not detected either in BH percentiles (p=0.915) or in BW deviation percentages in relation to the ideal rate (p=0.476). Conclusion. GFD applied for 1-3 years has a highly significant effect on the growth rate and nutritional status of children with the classical form of CD. Significant differences in these parameters of the disease were not detected between strictly compliant and non-compliant patients on GFD.

Keywords: coeliac disease, gluten-free diet, growth and nutritional status, children