Shifts in Pediatric Celiac Disease Presentation Over Two Decades (+Video)

Celiac.com 02/10/2025 - A recent study examined how body mass index (BMI) at the time of diagnosis has shifted among children with celiac disease over 16 years in Israel. By analyzing a large database of newly diagnosed children, researchers explored the relationship between BMI, socioeconomic status, ethnicity, and other demographic factors. The findings challenge traditional assumptions about celiac disease as a condition primarily associated with underweight individuals and highlight the importance of early, accurate diagnosis.

Key Trends in BMI at Diagnosis

The study analyzed records of over 5,500 children diagnosed with celiac disease between 2002 and 2018. At diagnosis, 73% of the children had a normal BMI, while 13.1% were underweight, 9.1% were overweight, and 4.8% were obese. Over time, the prevalence of underweight children decreased significantly, while rates of overweight and obesity remained largely stable. Notably, underweight and obese children were generally older at diagnosis, with an average age of 9 years compared to 8 years for those with normal or overweight BMIs.

Socioeconomic and Ethnic Factors

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The study highlighted significant socioeconomic and ethnic disparities in BMI categories. Children from lower socioeconomic backgrounds were more likely to be underweight at diagnosis, likely due to delayed access to healthcare and limited nutritional resources. Conversely, obesity was more common among children from higher socioeconomic groups, particularly those of Jewish ethnicity. Arab children, who were overrepresented in the underweight group, may experience diagnostic delays until symptoms become severe.

Changing Understanding of Celiac Disease

Historically, celiac disease was associated with malnutrition and growth failure, driven by intestinal damage and nutrient malabsorption. However, the study's findings reflect a broader trend observed globally: increasing rates of overweight and obesity among individuals with celiac disease. This shift may be due to earlier diagnoses, changes in dietary patterns, or broader societal trends in childhood obesity. The results emphasize that celiac disease can present across the full spectrum of BMI categories, including those traditionally considered less typical, such as obesity.

Diagnostic and Clinical Implications

The findings underscore the importance of considering celiac disease as a possible diagnosis regardless of BMI. Relying on weight as a key indicator may delay diagnosis in overweight or obese children, who might not fit the traditional clinical picture. Additionally, the study revealed gender differences, with male patients at higher risk of being obese or underweight at diagnosis compared to females.

The increasing use of non-invasive serological testing for celiac disease has expanded diagnosis rates and captured more atypical presentations. However, socioeconomic and cultural factors continue to influence diagnostic patterns, necessitating targeted efforts to ensure early and equitable access to care.

Broader Implications and Recommendations

The study suggests that rising rates of overweight and obesity in celiac disease may be driven by several factors, including improved disease recognition, epigenetic changes, gut microbiota shifts, and broader public health trends. These findings have implications for healthcare providers, who must remain vigilant for celiac disease in children with diverse clinical presentations. Addressing disparities in healthcare access and understanding ethnic and socioeconomic influences on diagnosis will be critical for improving outcomes.

Why This Matters for Families Managing Celiac Disease

For families navigating celiac disease, this study offers several takeaways. It reinforces the need for early screening, even in children who are not underweight, and highlights the diverse ways celiac disease can present. The research also emphasizes the importance of recognizing risk factors, such as socioeconomic status, that may delay diagnosis. By understanding these nuances, families can better advocate for timely testing and appropriate care, ensuring children with celiac disease receive the support they need to thrive.

Read more at: springermedicine.com

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