Growth failure and insulin-like growth factor (IGF-I) in childhood celiac disease.

The prevalence of underweight, short stature, and abnormal laboratory tests was assessed in a retrospective study of 335 patients with biopsy-verified childhood celiac disease (CCD). Of the patients younger than 2 years old, 67.4% were underweight (body weight: less than - 2SD) and 33.9% were short (height: less than - 2SD). In children older than 2 years, underweight was present in 36.0% of patients; the prevalence of short stature was 50.0%. Therefore, diagnostic procedures related to CCD appear justified in all children with short stature of unknown etiology. However, because 50% of patients were neither short nor underweight, normal height and weight should not preclude workup of a patient with symptoms suggestive of CCD. Of the laboratory tests evaluated, antigliadin antibodies were the most sensitive for CCD. Insulin-like growth factor (IGF-I) serum levels were prospectively studied in 62 patients (32 CCD patients, 30 controls) referred for jejunal biopsy. IGF-I levels were significantly lower in female CCD patients than in control patients. There was a significant negative association between the duration of gluten exposure and IGF-I levels. Results indicate that significant reduction in IGF-I levels in CCD patients occurs only after prolonged gluten exposure but before growth failure. Reevaluation of IGF-I levels on a glutenfree diet showed rapid reversal of reduced IGF-I values.