Screening for celiac disease among children with overweight and obesity: toward exploring celiac iceberg

J Pediatr Endocrinol Metab. 2020 Jul 13;/j/jpem.ahead-of-print/jpem-2020-0076/jpem-20200076.xml.doi: 10.1515/jpem-2020-0076. Online ahead of print.

Valeria Calcaterra 1 2, Corrado Regalbuto 1 3, Matteo Manuelli 4, Catherine Klersy 5, Gloria Pelizzo 2 6, Riccardo Albertini 7, Federica Vinci 1 3, Daniela Larizza 1 3, Maureen M Leonard 8 9, Hellas Cena 4 10


Author information

  • 1Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.
  • 2Pediatric Surgery Unit, Children's Hospital "Vittore Buzzi", Milano, Italy.
  • 3Pediatric Endocrinologic Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • 4Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
  • 5Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • 6Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy.
  • 7Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • 8Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, Massachusetts, USA.
  • 9Division of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Harvard Medical School, Boston, MA, USA.
  • 10Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy.


Background The coexistence of celiac disease (CD) and obesity/overweight is not unusual. Objective We investigate the prevalence and clinical presentation of CD, detected by screening, among children with excessive weight gain. Methods We enrolled 200 children referred for overweight/obesity to our outpatient clinic. Medical history during pregnancy and childhood and lifestyle variables were recorded. Patients were screened for CD with total immunoglobulin A (IgA), IgA anti-transglutaminase (tTG-IgA) and IgA anti-endomysial antibodies (EMA-IgA). In subjects with positive autoantibodies, esophagogastroduodenoscopy (EGDS) was performed and genetic testing for HLA DQ2 and/or DQ8 haplotypes was tested. Results CD positive antibodies (tTg-IgA and EMA-IgA) were detected in eight patients (4%); in all subjects CD diagnosis was confirmed by HLA-DQ2 and/or DQ8 compatibility and EGDS. No association between CD and medical history during pregnancy and childhood or lifestyle variables was noted; however, a dietary difference was identified with those testing positive for CD also reporting a lower weekly consumption of fruits and vegetables (p=0.04). Headache was reported more frequently in patients with than without CD (p=0.04). Familiar positivity for autoimmune diseases was revealed in CD patients (p=0.01). Conclusion CD should be considered in children with excessive weight gain. Familial predisposition to other autoimmune diseases may represent a risk factor for development of CD. Even though the relationship between headache and CD is not well defined, the patients with headache of unknown origin should be screened for CD.

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