Ceyda TUNA KIRSAÇLIOĞLU, Aydan TANCA, Zarife KULOĞLU, Ayhan Gazi KALAYCI, Gönül ÖCAL, Nuriye Özlem KÜÇÜK, Arzu ENSARİ, Nurten İRGİN, Zehra AYCAN

Bone mineral density and growth in children with coeliac disease on a gluten free-diet

Background/aim: To evaluate changes in growth and bone metabolism during consumption of a gluten-free diet (GFD) in children with coeliac disease (CD). Materials and methods: Thirty-seven children with CD (mean age of 8.8 ± 4.6 years, 21 girls) were enrolled. Anthropometric measurements, bone mineral density (BMD) in lumbar 2 4 vertebrae, and serum alkaline phosphatase, calcium, and phosphorus levels at diagnosis and at follow-up were recorded. Results: The mean follow-up period was 3.5 ± 2.3 years. The BMD of patients was significantly lower than that of control subjects at the time of diagnosis but not after 1 year of the GFD. Incidence of low BMD with respect to z-scores for chronological age (CA) was significantly higher than z-scores for height age (HA) (P = 0.006). At the first year of GFD, BMD, BMD z-score, height-for-age z-scores, and weight-for-age z-scores were significantly increased compared with the baseline, but not after 1 year of the GFD. Conclusion: In CD, the first year of GFD is important in weight gain, linear growth, and improvement of BMD. A considerable relation of low BMD in children with CD, with respect to z-scores for CA, may be a result of misinterpretation of low BMD due to short stature.

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1. Krupa-Kozak U. Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment. Nutrition 2014; 30: 16- 24.
2. Larussa T, Suraci E, Nazionale I, Abenavoli L, Imeneo M, Luzza F. Bone mineralization in celiac disease. Gastroenterol Res Pract 2012; 2012: 198025.
3. Lucendo AJ, Garcia-Manzanares A. Bone mineral density in adult coeliac disease: an updated review. Rev Esp Enferm Dig 2013; 105: 154-162.
4. Kalayci AG, Kansu A, Girgin N, Kucuk O, Aras G. Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood. Pediatrics 2001; 108: E89.
5. Tau C, Mautalen C, De Rosa S, Roca A, Valenzuela X. Bone mineral density in children with celiac disease. Effect of a gluten-free diet. Eur J Clin Nutr 2006; 60: 358-363.
6. Turner J, Pellerin G, Mager D. Prevalence of metabolic bone disease in children with celiac disease is independent of symptoms at diagnosis. J Pediatr Gastroenterol Nutr 2009; 49: 589-593.
7. Sdepanian VL, de Miranda Carvalho CN, de Morais MB, Colugnati FA, Fagundes-Neto U. Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in Sao Paulo, Brazil. J Pediatr Gastroenterol Nutr 2003; 37: 571-576.
8. Kemppainen T, Kroger H, Janatuinen E, Arnala I, LambergAllardt C, Karkkainen M, Kosma VM, Julkunen R, Jurvelin J, Alhava E et al. Bone recovery after a gluten-free diet: a 5-year follow-up study. Bone 1999; 25: 355-360.
9. Barera G, Beccio S, Proverbio MC, Mora S. Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a glutenfree diet. Am J Clin Nutr 2004; 79: 148-154.
10. Jatla M, Zemel BS, Bierly P, Verma R. Bone mineral content deficits of the spine and whole body in children at time of diagnosis with celiac disease. J Pediatr Gastroenterol Nutr 2009; 48: 175-180.
11. Szathmari M, Tulassay T, Arato A, Bodanszky H, Szabo A, Tulassay Z. Bone mineral content and density in asymptomatic children with coeliac disease on a gluten-free diet. Eur J Gastroenterol Hepatol 2001; 13: 419-424.
12. Gafni RI, Baron J. Overdiagnosis of osteoporosis in children due to misinterpretation of dual-energy x-ray absorptiometry (DEXA). J Pediatr 2004; 144: 253-257.
13. Rauch F, Schoenau E. Changes in bone density during childhood and adolescence: an approach based on bones biological organization. J Bone Miner Res 2001; 16: 597-604.
14. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C et al. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136-160.
15. Shaw NJ. Management of osteoporosis in children. Eur J Endocrinol 2008; 159 Suppl 1: S33-39.
16. Neyzi O, Furman A, Bundak R, Gunoz H, Darendeliler F, Bas F. Growth references for Turkish children aged 6 to 18 years. Acta Paediatr 2006; 95: 1635-1641.
17. Gokcay G, Furman A, Neyzi O. Updated growth curves for Turkish children aged 15 days to 60 months. Child Care Health Dev 2008; 34: 454-463.
18. Margoni D, Chouliaras G, Duscas G, Voskaki I, Voutsas N, Papadopoulou A, Panayiotou J, Roma E. Bone health in children with celiac disease assessed by dual x-ray absorptiometry: effect of gluten-free diet and predictive value of serum biochemical indices. J Pediatr Gastroenterol Nutr 2012; 54: 680-684.
19. Motta ME, Faria ME, Silva GA. Prevalence of low bone mineral density in children and adolescents with celiac disease under treatment. Sao Paulo Med J 2009; 127: 278-282.
20. Mora S, Barera G, Beccio S, Proverbio MC, Weber G, Bianchi C, Chiumello G. Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients. Am J Gastroenterol 1999; 94: 398-403.
21. Kavak US, Yuce A, Kocak N, Demir H, Saltik IN, Gurakan F, Ozen H. Bone mineral density in children with untreated and treated celiac disease. J Pediatr Gastroenterol Nutr 2003, 37: 434-436.
22. Carbone MC, Pitzalis G, Ferri M, Nenna R, Thanasi E, Andreoli A, De Lorenzo A, Bonamico M. Body composition in coeliac disease adolescents on a gluten-free diet: a longitudinal study. Acta Diabetol 2003; 40 Suppl 1: S171-173.
23. Scotta MS, Salvatore S, Salvatoni A, De Amici M, Ghiringhelli D, Broggini M, Nespoli L. Bone mineralization and body composition in young patients with celiac disease. Am J Gastroenterol 1997; 92: 1331-1334.
24. Mora S, Barera G, Ricotti A, Weber G, Bianchi C, Chiumello G. Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr 1998; 67: 477-481.
25. Ciacci C, Maurelli L, Klain M, Savino G, Salvatore M, Mazzacca G, Cirillo M. Effects of dietary treatment on bone mineral density in adults with celiac disease: factors predicting response. Am J Gastroenterol 1997; 92: 992-996.
26. Gemme G, Vignolo M, Naselli A, Garzia P. Linear growth and skeletal maturation in subjects with treated celiac disease. J Pediatr Gastroenterol Nutr 1999; 29: 339-342.
27. Patwari AK, Kapur G, Satyanarayana L, Anand VK, Jain A, Gangil A, Balani B. Catch-up growth in children with latediagnosed coeliac disease. Br J Nutr 2005; 94: 437-442.