Research article

Screening rules for growth to detect celiac disease: A case-control simulation study

Paula van Dommelen^{* 1} , Floor K Grote^{* 2} , Wilma Oostdijk² , Sabine MPF de Muinck Keizer-Schrama³ , Bart Boersma⁴ , Gerard M Damen⁵ , Cassandra G Csizmadia² , Paul H Verkerk⁶ , Jan M Wit² and Stef van Buuren^1,7

¹Dept. of Statistics, TNO Quality of life, Leiden, The Netherlands

²Dept. of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

³Dept. of Pediatrics, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands

⁴Dept. of Pediatrics, Medical Center Alkmaar, Alkmaar, The Netherlands

⁵Dept. of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands

⁶Dept. of Child Health, TNO Quality of life, Leiden, The Netherlands

⁷Dept. of Methodology & Statistics, University of Utrecht, The Netherlands

author email corresponding author email* Contributed equally

BMC Pediatrics 2008, 8:35doi:10.1186/1471-2431-8-35

Published:	11 September 2008

Abstract

Background

It is generally assumed that most patients with celiac disease (CD) have a slowed growth in terms of length (or height) and weight. However, the effectiveness of slowed growth as a tool for identifying children with CD is unknown. Our aim is to study the diagnostic efficiency of several growth criteria used to detect CD children.

Methods

A case-control simulation study was carried out. Longitudinal length and weight measurements from birth to 2.5 years of age were used from three groups of CD patients (n = 134) (one group diagnosed by screening, two groups with clinical manifestations), and a reference group obtained from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort (n = 2,151) in The Netherlands. The main outcome measures were sensitivity, specificity and positive predictive value (PPV) for each criterion.

Results

Body mass index (BMI) performed best for the groups with clinical manifestations. Thirty percent of the CD children with clinical manifestations and two percent of the reference children had a BMI Standard Deviation Score (SDS) less than -1.5 and a decrease in BMI SDS of at least -2.5 (PPV = 0.85%). The growth criteria did not discriminate between the screened CD group and the reference group.

Conclusion

For the CD children with clinical manifestations, the most sensitive growth parameter is a decrease in BMI SDS. BMI is a better predictor than weight, and much better than length or height. Toddlers with CD detected by screening grow normally at this stage of the disease.