Celiac in the twenty-first century-the change in BMI of children at diagnosis over the last two decades

Rim Kasem Ali Sliman; Nili Stein; Yigal Elenberg Alter

doi:10.1007/s00431-024-05835-6

Celiac in the twenty-first century-the change in BMI of children at diagnosis over the last two decades

Eur J Pediatr. 2024 Dec 26;184(1):105. doi: 10.1007/s00431-024-05835-6.

Authors

Rim Kasem Ali Sliman^{1

2}, Nili Stein³, Yigal Elenberg Alter^{4

5

6}

Affiliations

¹ Technion - Israel Institute of Technology, Haifa, Israel. k.rim@technion.ac.il.
² Department of Pediatrics, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel. k.rim@technion.ac.il.
³ Data Research and Statistician Center, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel.
⁴ Technion - Israel Institute of Technology, Haifa, Israel.
⁵ Department of Pediatrics, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel.
⁶ Pediatric Gastroenterology Unit, Carmel Medical Center, Haifa, Israel.

PMID: 39722061
DOI: 10.1007/s00431-024-05835-6

Abstract

This study examined the prevalence of different BMI categories among newly diagnosed pediatric celiac disease (CD) patients in Israel from 2002 to 2018. A retrospective cross-sectional study using the database of Clalit Health Services in Israel included 5520 newly diagnosed CD children aged 2-18 between 2002 and 2018. Data on BMI, gender, ethnicity, and socioeconomic status (SES) were collected and analyzed Of the 5520 CD patients, 57.5% were female, 39.7% had low SES, and 77.1% were Jewish. At diagnosis, 13.1% were underweight, 73% had normal BMI, 9.1% overweight, and 4.8% were obese. Underweight and obese patients tended to be older at diagnosis (9 years) compared with normal and overweight patients (8 years) (P < 0.001). A higher proportion of Arab patients were underweight, while more Jewish patients were obese. Lower SES was significantly associated with increased underweight risk (P < 0.001). Over time, diagnosed patients had improved SES and were less underweight (P < 0.001). Male gender increased obesity risk (OR 1.36 [95% CI 1.06-1.74], P = 0.017), while Arab ethnicity was protective for obesity (OR 0.67 [95% CI, (0.45-0.99)], P = 0.047)Conclusion: Underweight prevalence significantly decreased in the second decade, but no significant change in overweight and obesity was noted. Underweight was associated with older age at diagnosis, poverty, and Arab ethnicity. Obesity was associated with older age and was more frequent in Jewish and male patients. Physicians should have a low threshold for CD screening regardless of BMI status to enable timely diagnosis and treatment to prevent long-term health consequences. What Is Known: • Celiac disease is traditionally associated with underweight due to malabsorption, but recent reports suggest an increasing prevalence of overweight and obesity in pediatric patients at diagnosis What Is New: • This study found that underweight prevalence decreased significantly over time, while overweight and obesity prevalence remained unchanged. Underweight was associated with older age, poverty, and Arab ethnicity, while obesity was more common in Jewish and male patients.

Keywords: BMI; Celiac; Obesity; Overweight; Pediatrics; Underweight.

MeSH terms

Adolescent
Arabs / statistics & numerical data
Body Mass Index*
Celiac Disease* / diagnosis
Celiac Disease* / epidemiology
Child
Child, Preschool
Cross-Sectional Studies
Female
Humans
Israel / epidemiology
Jews / statistics & numerical data
Male
Overweight / epidemiology
Pediatric Obesity* / diagnosis
Pediatric Obesity* / epidemiology
Prevalence
Retrospective Studies
Thinness* / epidemiology