Eur J Pediatr. 2024 Aug 27. doi: 10.1007/s00431-024-05721-1. Online ahead of print.

Tal Ben-Ami ^# 1 2 3, Anna Trotskovsky ⁴, Chani Topf-Olivestone ⁵, Michal Kori ^# 4 6 7

Author information

¹Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel. tal.ben.ami11@gmail.com.

²Pediatric Hematology-Oncology Unit, Kaplan Medical Center, Pasternak St, Rehovot, Israel. tal.ben.ami11@gmail.com.

³Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. tal.ben.ami11@gmail.com.

⁴Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel.

⁵Pediatric Gastroenterology, Assuta Medical Center, Ashdod, Israel.

⁶Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

⁷Pediatric Gastroenterology, Kaplan Medical Center, Rehovot, Israel.

^#Contributed equally.

Abstract

Iron deficiency (ID) without anemia is common in children with newly diagnosed celiac disease (CD). We aimed to assess the effect of iron supplementation versus no treatment on ferritin levels in newly diagnosed CD patients with ID adhering to a gluten-free diet (GFD). A retrospective review of children < 18 years, with low ferritin (≤ 10 ng/mL) and normal hemoglobin levels diagnosed between 12.2018 and 12.2021. We compared hemoglobin and ferritin levels between patients who received supplemental iron to those who did not. Data, including demographics, laboratory tests, and anthropometrics, were collected at baseline, and at 6 and 12 months following the initiation of the GFD. Adherence to GFD was assessed at each visit. Among 304 children diagnosed during the study period, 43 (14.1%) had iron deficiency anemia and 60 (19.7%) ID without anemia. Among children with ID, 29 (48%) were female, mean age 7.3 ± 3.9 years. Twenty-nine (48%) children received iron supplementation, and 31 (52%) did not. At the 12-month follow-up visit, tissue transglutaminase levels decreased significantly (p < 0.001), from a mean baseline level of 226.6 ± 47.8 to 34.5 ± 46 U/mL in children that received iron supplementation and from 234.2 ± 52.4 to 74.5 ± 88.7 U/mL in non-treated children, with no significant difference between the groups p = 0.22. Ferritin levels increased significantly (p < 0.001), from 9.0 ± 4.7 to 25.2 ± 20.8 ng/mL in patients who received supplementation and from 8.9 ± 3.8 to18.6 ± 9.5 ng/mL in patients who did not, with no significant difference between the groups (p = 0.46).

Conclusion: Most children with newly diagnosed celiac disease and iron deficiency, who adhere to GFD, will normalize ferritin levels within 12 months without the need of iron supplementation.

What is known: • Iron deficiency and iron deficiency anemia are common in newly diagnosed celiac disease. • Improved iron absorption may follow mucosal healing process in patients adhering to a strict gluten-free diet.

What is new: • This single-center, retrospective cohort study evaluated the effect of iron supplementation versus no treatment on ferritin levels in children with newly diagnosed celiac disease with iron deficiency adhering to a gluten-free diet. • Most children with newly diagnosed celiac disease and iron deficiency, who adhere to gluten-free diet, will normalize ferritin levels within 12 months without the need of iron supplementation.