The CHIC Study: Child Health in Coeliac Disease

Coeliac disease (CD) is an autoimmune condition of the gastrointestinal tract. In untreated patients, an inflammatory response to gluten results in destruction of the gut mucosa resulting in villus atrophy. This often presents with overt clinical symptoms but can also be silent in nature. Continual gluten insult can inevitably lead to a range of complications including nutritional problems from poor growth to deficits in bone mineral density (BMD). The CHIC study aimed to create a comprehensive picture of CD in children, taking into account growth and nutritional status, bone health, micronutrient status and further assessing children with the dual diagnosis of type 1 diabetes mellitus and CD. It is well established that early diagnosis of CD and the prompt initiation of gluten free dietary treatment (GFD) reduces the manifestation of complications. Yet in many previous studies the quality of a GFD and children's compliance to it have not been accounted for. This study assessed nutritional status and body composition in paediatric patients with newly diagnosed CD and found that the presentation of CD has changed, with the majority of patients presenting with normal and even over nutrition. Furthermore, the introduction of GFD with good compliance supports normal growth velocities and enables catch up growth in children presenting with short stature. When considering bone health in paediatric patients with CD the results remain inconclusive. Many previous studies have used the widely available DXA to assess bone mineral content, but in paediatric patients this may not accurately determine bone health. This study used peripheral quantitative computed tomography to distinguish changes in bone mineral density and investigate any alterations in bone microarchitecture. Thus, for the first time in paediatric CD patients identifying disruption to the remodelling mechanisms of trabecular bone, which may be particularly sensitive to resorption and mineral loss in patients with active CD. Furthermore, restoration of BMD was evident with good compliance to dietary treatment. Investigations into micronutrient status revealed that newly diagnosed children are vulnerable to micronutrient deficiency, this is likely due to malabsorption in the gut in patients with active CD. Deficiencies in zinc and magnesium were also identified in children treated with a GFD. This may be due to the inadequate micronutrients intakes with consumption levels of riboflavin, vitamin A, vitamin K, calcium, iron, magnesium and zinc lower than expected in treated CD children