Normal Growth & Nutrition for Asian Celiacs on Gluten-Free Diet

Celiac.com 11/22/2007 - Faced with a lack of data on growth rates and histological recovery in Asian children with celiac disease, a team of doctors led by Surender K. Yachna set out to evaluate the result of a gluten-free diet.

The study findings appear in the Journal of Gastroenterology & Hepatology. The research team looked at forty-two children with celiac disease.

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The team chronicled weight and height as weight for height (WFH) and height standard deviation scores (HSDS) deviation scores. 25 of the 42 children underwent duodenal biopsies after 1 and 2 years, while 14 of the children underwent a third biopsy after being on a gluten-free diet for 3-7 years. The research team measured compliance with a gluten-free diet in the children using regular interviews & IgA anti-endomysial antibody estimation (EMA).

The average HSDS was 3.3 + 1.6 with 76% showing an HSDS of <-2, with 60% of the children undernourished, with an average WfH of 81.6 + 5.7.

Over an average follow-up span of 3.7 years, the HSDS improved significantly to -1.3 + 1.7, with 84% of cases achieving normal nutrition. The average growth rate was 13.9 cm for the first year, and 5.6 cm in the following years.

The small bowel biopsies conducted upon diagnosis revealed Marsh IIIb subtotal villous atrophy in 18, or 72%, of the patients, and partial villous atrophy in 7, or 28%. Follow-up biopsy after 1-2 years revealed a change to partial villous atrophy in 17 of the 18 who originally showed Marsh IIIb subtotal villous atrophy. One patient showed a normal biopsy. All 7 patients who originally showed partial villous atrophy showed improvement.

81% of the patients showed negative results for IgA endomysial antibody. Follow-up biopsies conducted after 5 years of Gluten-free Diet showed improvement to Marsh I-II, but no normalization.

From these results, the team concluded that most children with celiac disease exhibit normal nutritional uptake and growth patterns with the introduction of a gluten-free diet, and that most also show significant improvement in small bowel histology, but none show normalization, even after 5 years of a dedicated gluten-free diet.

Journal of Gastroenterology Hepatology. 2007; 22(8): 1300-1305