Effect of BMI and symptoms at celiac disease diagnosis on serology normalization after 2 years of a gluten-free diet in children

Objectives: To determine if after 2 years of consuming a gluten-free diet post celiac disease diagnosis, pediatric patients who were overweight or obese at diagnosis are less likely to normalize celiac disease serologies as compared with those who were normal weight or underweight at diagnosis. Secondary aims include characterizing how initial symptoms at presentation predict body mass index (BMI) change and serology improvement over the first 2 years of being on a gluten-free diet following diagnosis of celiac disease.

Methods: A retrospective chart review was performed that included all biopsy-proven celiac disease patients followed at Stony Brook Children's Hospital's Celiac Disease Center diagnosed between the years 2007-2022. This included all patients between 2 and 18 years of age who had their BMI documented at the time of diagnosis and at least one additional BMI documented 2 years ± 12 months after starting the gluten-free diet. Data collected included BMI and celiac serology at and 2 years ± 12 months after diagnosis as well as symptoms, sex, age, race, and ethnicity at diagnosis.

Results: The charts of 229 pediatric patients with Celiac Disease were reviewed. Out of 229 patients, 89 had BMIs and celiac serologies available at diagnosis and at 2-year follow-up which were included. Based on multivariable logistic regression model, patients with overweight or obese BMI at baseline were not less likely (odds ratio [OR] = 0.97, 95% confidence interval [CI]: 0.29-3.27) to normalize their celiac serologies at 2-year follow-up visit as compared with patients who were normal weight or underweight at baseline. Patients with GI symptoms at diagnosis were more likely (OR = 3.86, 95% CI: 1.29, 11.54) to normalize their celiac serologies at 2-year follow-up visit as compared with patients without GI symptoms at diagnosis.

Conclusions: Rate of normalization of celiac serologies 2 years after initiating a gluten-free diet showed no difference between the overweight or obese and normal weight or underweight pediatric populations. However, patients with GI symptoms at diagnosis were more likely to normalize their celiac serologies by 2-year follow-up visit, suggesting they may be more likely to comply with the gluten-free diet.