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. 2008 Sep 11:8:35.
doi: 10.1186/1471-2431-8-35.

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

Paula van Dommelen  1 , Floor K Grote, Wilma Oostdijk, Sabine M P F de Muinck Keizer-Schrama, Bart Boersma, Gerard M Damen, Cassandra G Csizmadia, Paul H Verkerk, Jan M Wit, Stef van Buuren
Affiliations

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

Paula van Dommelen et al. BMC Pediatr. .

Abstract

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.

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Figures

Figure 1
Figure 1
Flow chart of children with CD used in the study.
Figure 2
Figure 2
ROC plot of effective growth screening rules for detecting CD in the symptomatic group. The rules are an absolute change in BMI SDS with or without the restriction of a low BMI SDS, a slowed growth for BMI, and a conditional weight gain in combination with a low weight SDS.
See this image and copyright information in PMC

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