Growth Stunting and Nutritional Deficiencies Among Children and Adolescents with Celiac Disease in Kuwait: A Case-Control Study

Abstract

Abstract Background Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion in genetically predisposed individuals. It can lead to chronic bowel inflammation and cause serious adverse consequences on children's health and development, including failure to thrive (FTT) or impaired growth. Currently, data on pediatric CD in Kuwait are limited. Objective We aimed to assess the nutritional status of children and adolescents with CD in Kuwait and investigate the nutritional deficiencies and sociodemographic factors associated with growth stunting in this population. Methods This case-control study included aged 3–18 years. Cases (n = 77) were diagnosed with CD using IgA-anti tissue transglutaminase (IgA TTG antibodies) and duodenal biopsy and compared to a healthy control group (n = 33). Nutritional status was evaluated using demographic and clinical characteristics, anthropometric measurements, and biochemical parameters. Univariate and multivariate logistic regression models were used to determine the association between CD and growth stunting. Results Approximately a third (31%) of children with CD had stunted growth, 20.8% had low BMI for age, and 5.2% had both growth stunting and wasting. Children with CD had higher odds of iron deficiency anemia (IDA) [OR = 8.00 [1.771–36.135]; p = .007; and vitamin D deficiency [OR = 6.65 [1.91–16.71], p = .002. Lower socioeconomic status [aOR = .309 (.169-.565), p < .001], anemia [aOR = 14.76 (2.41–90.36), p = .004], decreased serum level of vitamin D [aOR = .369 (.181-.753), p = .006], and being in a younger age group [aOR = .284 (.114-.707), p = .007] were factors significantly associated with higher risk of CD, explaining more than 50% of the risk (R2 = .509). For growth stunting, lower education status in the mother [aOR = .380 (.177-.817), p = .013], lower family income [aOR = .458 (.235-.894), p = .022], and lower serum ferritin [aOR = .227 (.060-.860), p = .029] were identified as risk factors (R2 = 516). Conclusion A significant proportion of children and adolescents with CD had malnutrition, overt deficiencies, and impaired growth despite coherence with a gluten free diet (GFD). Screening for deficiencies and regular follow-up with a dietitian are important to track dietary habits, follow up on GFD adherence, and correct nutritional deficiencies. Special attention should be paid to children from families with economic disparities.