Abstract
Background
Celiac disease (CD) in children and adolescents has been linked with increased susceptibility for cardiometabolic disease in adulthood. We explored the interaction between body composition and metabolic syndrome (MetS) components in pediatric CD.
Methods
We conducted a retrospective observational study of patients with CD followed at our Pediatric Endocrine and Gastroenterology Units between 1/2018-1/2022. Data on sociodemographic, clinical, laboratory, and body composition parameters (bioelectrical impedance analysis, BIA) were collected.
Results
Forty-four patients with MetS components and 67 patients without them were enrolled. The cohort’s mean age at BIA assessment was 11.5 ± 3.6 years. Individuals with MetS components were older (P = 0.045), had higher BMI z-scores (P < 0.001), higher total and truncal fat percentage levels (P < 0.001), lower muscle-to-fat ratio z-scores (P = 0.018), higher sarcopenic indices (P = 0.05), higher systolic blood pressure percentiles (P = 0.001), higher triglycerides levels (P = 0.009), and higher triglycerides/HDL-c ratios (P < 0.001) than those without MetS components. A sex- and age-adjusted model revealed that the diagnosis of MetS components was positively associated with fat percentage (odds ratio = 1.087, confidence interval [1.010–1.171], P = 0.027), but not with BMI z-scores (P = 0.138).
Conclusions
We found that fat percentage but not weight status is associated with risk for MetS components in individuals with childhood-onset CD. Preventive interventions should target an improvement in body composition.
Impact
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The literature on cardiometabolic risk in pediatric patients with celiac disease (CD) is sparse.
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Our analysis revealed that at least one metabolic syndrome (MetS) component was present in two out of every five children and adolescents with CD.
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An increase in fat percentage but not in body mass index z-scores predicted the presence of MetS components in our cohort.
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These findings suggest that the weight status of children and adolescents with CD does not mirror their risk for MetS components.
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Body composition analysis should be considered as an integral part of the clinical evaluation in young patients with CD.
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Data availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
This work was performed by Oren Kassner in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. We are grateful to Esther Eshkol for editorial assistance.
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A.Y.-F. substantial contribution to the conception and design of the study, interpretation of data analysis and drafting of the article. O.K. made a substantial contribution to the design of the study, curation, statistical analysis and interpretation of the data and drafting of the article. Y.F., H.M.-L., A.A., D.L., H.I., E.E.-T., and S.C. made a substantial contribution to the curation and interpretation of the data and revised the manuscript for important intellectual content. Y.L. and A.B. made a substantial contribution to the conception and design of the study, interpretation of data analysis and revised the manuscript for important intellectual content incorporating the comments of all co-authors. A.B. is the guarantor of this work, and as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version.
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The study was approved by the Ethics Committee of the Tel-Aviv Sourasky Medical Center according to the Helsinki Declaration. Informed consent by the participants was waived since the data were retrieved from the subjects’ medical records and all personal identification was omitted.
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Yerushalmy-Feler, A., Kassner, O., Frank, Y. et al. Body composition in pediatric celiac disease and metabolic syndrome component risk—an observational study. Pediatr Res 94, 618–625 (2023). https://doi.org/10.1038/s41390-023-02496-3
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DOI: https://doi.org/10.1038/s41390-023-02496-3
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