https://ijmri.de/index.php/jmsi
volume 4, issue 5, 2025
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THE IMPACT OF CELIAC DISEASE ON GROWTH AND DEVELOPMENT IN
CHILDREN
Author:
Ermatov Farhod Ahmedovich
Assistant, Department of Pediatrics and Pediatric Surgery,
Central Asian Medical University, Independent Doctoral Researcher
Abstract:
Celiac disease is a chronic immune-mediated enteropathy triggered by gluten in
genetically predisposed individuals. In children, the condition is of particular concern as it
impairs nutrient absorption during critical periods of physical and cognitive development. This
article comprehensively explores the impact of celiac disease on pediatric growth,
musculoskeletal formation, neurological function, and emotional stability. It discusses
pathogenesis, clinical manifestations, diagnostic strategies, and the transformative role of a
gluten-free diet. The study emphasizes early diagnosis, long-term dietary compliance, and a
multidisciplinary management strategy.
Keywords:
Celiac disease, gluten, growth delay, child development, gluten-free diet,
malabsorption, pediatric nutrition.
Contents
1. Introduction
2. Etiology and Pathogenesis
3. Clinical Manifestations in Children
4. Diagnostic Criteria and Monitoring
5. Impact on Growth and Development
6. Role of Gluten-Free Diet in Recovery
7. Regional Challenges and Recommendations
8. Conclusion
9. References
1. Introduction
Celiac disease (CD) is a multisystem autoimmune disorder that primarily affects the small
intestine in response to gluten ingestion. In children, undiagnosed or unmanaged CD can
significantly impair growth and development, leading to long-term consequences such as stunted
height, bone deformities, and cognitive delays. The increasing prevalence of CD globally,
particularly among children, highlights the importance of early recognition and management.
2. Etiology and Pathogenesis
Celiac disease is genetically linked, with HLA-DQ2 and HLA-DQ8 haplotypes present in over
95% of affected individuals. Upon ingestion of gluten, gliadin peptides are deamidated by tissue
transglutaminase (tTG), enhancing their affinity to HLA molecules. This triggers T-cell-
mediated inflammation, leading to villous atrophy, crypt hyperplasia, and intestinal permeability.
The resulting mucosal damage causes impaired absorption of essential nutrients critical for
growth.
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3. Clinical Manifestations in Children
Symptoms in children may vary by age:
- Infants: Chronic diarrhea, failure to thrive, abdominal distension
- Toddlers: Irritability, anorexia, delayed speech
- School-aged children: Short stature, delayed puberty, learning difficulties
Extraintestinal signs include iron-deficiency anemia, dental enamel defects, dermatitis
herpetiformis, and neurobehavioral disturbances.
4. Diagnostic Criteria and Monitoring
Diagnosis includes:
- Serological testing: Anti-tTG IgA and EMA are gold-standard tests.
- Endoscopic biopsy: Confirms villous atrophy using Marsh classification.
- Genetic testing: HLA-DQ2/DQ8 genotyping for unclear cases.
- Anthropometry: Routine tracking of height-for-age, weight-for-age, and BMI percentiles.
- Nutrient profiles: Iron, vitamin D, folate, and zinc assessments.
5. Impact on Growth and Development
Due to nutrient malabsorption, CD can cause:
- Linear growth retardation (height-for-age below 3rd percentile)
- Weight stagnation or loss
- Delayed bone age and low bone mineral density
- Impaired psychomotor development and cognitive delays
- Increased risk of depression and anxiety
Untreated CD during growth years may result in permanently stunted adult height and skeletal
immaturity.
6. Role of Gluten-Free Diet in Recovery
A lifelong, strict gluten-free diet (GFD) is the only effective treatment. Clinical improvements
are usually seen within months:
- Growth parameters normalize in 6–12 months
- Gastrointestinal symptoms resolve quickly
- Hematological markers recover (Hb, ferritin)
- Neurodevelopmental progress resumes
Nutritional counseling and supplementation (iron, calcium, vitamin D) are essential for full
recovery.
7. Regional Challenges and Recommendations
In developing regions like Central Asia:
- Gluten-free food availability is limited and costly
- Public and professional awareness is low
- Screening programs are not yet standardized
Recommendations:
- Introduce affordable gluten-free food alternatives
- Implement school health screening
- Train pediatricians in early recognition of CD
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- Encourage public education and food labeling policies
8. Conclusion
Celiac disease has a profound and multifaceted impact on the health of children. Timely
diagnosis, rigorous dietary compliance, and ongoing multidisciplinary support can reverse
growth failure and allow children to achieve normal development milestones. A comprehensive
public health approach is needed to improve early detection and management, particularly in
under-resourced settings.
9. References
1. Fasano A, Catassi C. Celiac Disease. N Engl J Med. 2012;367(25):2419–26.
2. Kaukinen K, Lindfors K. Celiac disease: Current concepts. J Intern Med. 2020.
3. Assa A et al. Growth in children with celiac disease. Am J Clin Nutr. 2017;105(2):544–551.
4. Lionetti E, Catassi C. Environmental Factors in Celiac Disease. Foods. 2021;10(2):1–15.
5. Ministry of Health Uzbekistan. National Pediatric Gastroenterology Protocol. Tashkent, 2022.
