There are multiple studies in the adult literature reporting the association of CD and obesity. Dickey et al (9) conducted a 10-year study to analyze the prevalence of increased BMI in CD and described that almost 39% of adult patients with CD were overweight at diagnosis, with 13% being obese. Nearly 82% of the overweight patients gained weight after 2 years on GFD. The authors attributed the weight gain and increase in body fat stores to improved intestinal absorption after gluten exclusion (9). In contrast, Murray et al (10) showed that 6% of 215 adult patients with CD were obese at diagnosis and 60% of these patients had a decrease in BMI after 6 months of GFD. The authors hypothesized that iron and micronutrient deficiency seen in patients with CD results in increased food craving leading to obesity, similar to increased intake seen in patients experiencing pica (10). West et al (11) found that 3.9% of 3590 patients with CD were obese and 17% were overweight. A 14-year follow-up study on compliance and quality of life of patients with CD conducted by Viljamaa et al (12) stated that 15% of 50 patients were in the obese category.
Because classic CD presents as failure to thrive and malabsorption during infancy and school age, most physicians include CD in the differential diagnosis of such children but not in those with obesity. Recent studies have described a changing pattern in the presentation of CD, which includes asymptomatic disease to atypical presentations including fatigue, seizures, behavioral problems, and dermatitis herpetiformis (7,17,18). Increasing number of asymptomatic patients are diagnosed after serologic screening performed in conditions associated with CD (ie, Down syndrome, type I diabetes mellitus). We describe yet another important subgroup of children, those who are obese, that may be missed if the diagnosis is not suspected.
One of the limitations of our study was that only a small group of children were identified and a prospective multicenter study involving a large group of children with long-term follow-up is required to identify the true association, prevalence, and outcome of CD and obesity.
1. Hoffenberg EJ, MacKenzie T, Barriga KJ, et al
. A prospective study of the incidence of childhood celiac disease
. J Pediatr 2003; 143:308–314.
2. Fasano A, Berti I, Gerarduzzi T, et al
. Prevalence of celiac disease
in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163:286–292.
3. Holmes GK. Screening for coeliac disease in type 1 diabetes. Arch Dis Child 2002; 87:495–498.
4. Bonamico M, Mariani P, Danesi HM, et al
. Prevalence and clinical picture of celiac disease
in Italian Down syndrome patients: a multicenter study. J Pediatr Gastroenterol Nutr 2001; 33:139–143.
5. Valentino R, Savastano S, Tommaselli AP, et al
. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm Res 1999; 51:124–127.
6. Ogden CL, Carroll MD, Curtin LR. Prevalence of overweight and obesity
in the United States, 1999–2004. JAMA 2006; 295:1549–1555.
7. Telega G, Bennet TR, Werlin S. Emerging new clinical patterns in the presentation of celiac disease
. Arch Pediatr Adolesc Med 2008; 162:164–168.
8. Marsh MN. Grains of truth: evolutionary changes in small intestinal mucosa in response to environmental antigen challenge. Gut 1990; 31:111–114.
9. Dickey W, Kearney N. Overweight in celiac disease
: prevalence, clinical characteristics, and effect of a gluten-free diet
. Am J Gastroenterol 2006; 101:2356–2359.
10. Murray JA, Watson T, Clearman B, et al
. Effect of a gluten-free diet
on gastrointestinal symptoms in celiac disease
. Am J Clin Nutr 2004; 79:669–673.
11. West J, Logan RF, Card TR, et al
. Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Aliment Pharmacol Ther 2004; 20:73–79.
12. Viljamaa M, Collin P, Huhtala H, et al
. Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther 2005; 22:317–324.
13. Conti Nibali S, Magazzu G, De Luca F. Obesity
in a child with untreated coeliac disease. Helv Paediatr Acta 1987; 42:45–48.
14. Lucille A, Semeraro MD, Kenneth W, et al
. Gryboski obesity
in celiac sprue. J Clin Gastroenterol 1986; 8:177–180.
15. Oso O, Fraser NC. A boy with coeliac disease and obesity
. Acta Paediatr 2006; 95:618–619.
16. Czaja-Bulsa G, Garanty-Bogacka B, Syrenicz M, et al
in an 18-year-old boy with untreated celiac disease
. J Pediatr Gastroenterol Nutr 2001; 32:226.
17. Hull CM, Liddle M, Hansen N, et al
. Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis. Br J Dermatol 2008; 159:120–124.
18. Brow JR, Parker F, Weinstein WM, et al
. The small intestinal mucosa in dermatitis herpetiformis. I. Severity and distribution of the small intestinal lesion and associated malabsorption. Gastroenterology 1971; 60:355–361.