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Screening rules for growth to detect celiac disease : A case-control simulation study

Author: Dommelen, P. van · Grote, F.K. · Oostdijk, W. · Muinck Keizer de · Schrama, S.M.P.F. · Boersma, B. · Damen, G.M. · Csizmadia, C.G. · Verkerk, P.H. · Wit, J.M. · Buuren, S. van
Institution: TNO Kwaliteit van Leven
Source:BMC Pediatrics, 8
Identifier: 241008
doi: doi:10.1186/1471-2431-8-35
Article number: 35
Keywords: Health · Jeugd en Gezondheid · Child growth · Clinical feature · Ccohort analysis · Controlled study · Diagnostic value · Gluten free diet · Major clinical study · Netherlands · Newborn · Prediction · Preschool child · Screening test · Simulation · Child development · Methodology · Standard · Statistics · Body Height · Body Mass Index · Body Weight · Case-Control Studies · Celiac Disease · Child Development · Child, Preschool · Female · Infant · Infant, Newborn · Male · Mass Screening · Netherlands · Prospective Studies · Sensitivity and Specificity


Background: It is generally assumed that most patients with celiac disease (CD) have a slowed growth in terms of length (or height) and weight. However, the effectiveness of slowed growth as a tool for identifying children with CD is unknown. Our aim is to study the diagnostic efficiency of several growth criteria used to detect CD children. Methods: A case-control simulation study was carried out. Longitudinal length and weight measurements from birth to 2.5 years of age were used from three groups of CD patients (n = 134) (one group diagnosed by screening, two groups with clinical manifestations), and a reference group obtained from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort (n = 2,151) in The Netherlands. The main outcome measures were sensitivity, specificity and positive predictive value (PPV) for each criterion. Results: Body mass index (BMI) performed best for the groups with clinical manifestations. Thirty percent of the CD children with clinical manifestations and two percent of the reference children had a BMI Standard Deviation Score (SDS) less than -1.5 and a decrease in BMI SDS of at least -2.5 (PPV = 0.85%). The growth criteria did not discriminate between the screened CD group and the reference group. Conclusion: For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS. BMI is a better predictor than weight, and much better than length or height. Toddlers with CD detected by screening grow normally at this stage of the disease. © 2008 van Dommelen et al; licensee BioMed Central Ltd.