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The presenting pattern of celiac disease (CD) at diagnosis in children has changed over time, with a reduction of malabsorption-related phenotypes and an increase in regular or even excessive growth patterns. We retrospectively reviewed the body mass index (BMI) distribution of all patients with a new diagnosis of CD made in a Pediatric Gastroenterology Outpatient Clinic in 1990-2011, compared to those diagnosed in 2012-2022, according to their clinical and serological characteristics. The 1990-2011 and 2012-2022 cohorts included 250 (M:F=90:160, mean age 7.36.1 years) and 243 children (M:F=81:162, mean age 7.13.7 years, NS), respectively. The prevalence of underweight (UW) was higher in the 1990-2011 cohort (61/250, 24.4% in 1990-2011 vs. 31/243, 12.7% in 2012-2022, p=0.0001), whereas that of overweight (OW) and obese (OB) subjects was significantly higher in 2012-2022 (10/250, 4% in 1990-2011 vs. 24/243, 9.9% in 2012-2022, p=0.012, and 1/250, 0.4% in 1990-2011 vs 8/243, 3.3% in 2012-2022, p=0.018, respectively). In both cohorts, gastrointestinal symptoms were more frequent in OW/OB than in UW children (6/11, 54.5% vs. 5/61, 8.2% in 1990-2011, p0.0001, and 24/32, 75% vs. 10/31, 32.3%, p0.0001 in 2012-2022) and the extent of anti-transglutaminase antibodies increase was similar in OW/OB and UW subjects. The prevalence of children with a normal or even high BMI at CD diagnosis has increased in the past three decades, therefore CD should be suspected regardless of the BMI status.
Monzani et al. (Fri,) studied this question.