Età del menarca e parametri auxologici in una coorte di adolescenti affette da celiachia

Introduction: Coeliac disease (CD) is an immune-mediated systemic disorder, triggered by the ingestion of gluten in genetically predisposed individuals. The typical clinical presentation includes abdominal symptoms; nevertheless about 60% of pediatric patients show extra-abdominal symptoms. Among these, growth impairment and sexual development disorder: 10-47% of the children at diagnosis show short stature, 10-20% show delayed puberty. For this reason, the ESPGHAN follow-up guidelines recommend regular measurement of anthropometric parameters and evaluation of pubertal development. The literature is controversial about growth in coeliac children: it is not clear whether the catch-up of growth is complete or whether a reduced stature could persist and there are no unique data regarding the possible variables that could influence the growth process, including diagnosis and menarche age. Aim: The purpose of this study is to evaluate which variables could influence the final height in a group of coeliac patients, focusing on the time of puberal development and diagnosis of CD. Materials and methods: This retrospective descriptive study required a medical records review of 84 female celiac patients born within 2008 and the analysis of the data of 43 celiac adolescents of a previous study, born between 1988 and 2002. The analyzed data are related to three moments in the patients' clinical history: diagnosis, menarche and the last visit. For each, we collect age and auxological parameters (weight, height, BMI and their related z-scores), as well as parents' height data to calculate the genetic target based on the Tanner formula. Other variables are final TGA-IgA levels, the type of diagnosis (histological or serological) and comorbidities, if present. Results: In the celiac group we found a significant positive correlation between age of menarche and final height (R = 0.263; p < 0.05), a finding congruous to what observed in the healthy population. Likewise, also the age of menarche (group 1: 12.1 ± 1.2 years; group 2: 11.8 ± 1.2 years) and the negative correlation between age at menarche and final BMI are in accordance with the healthy population. The onset age conversely has no effect on growth. Growth shows a relatively constant trend in terms of percentiles and subjects belonging to lower percentiles at onset tend to gain in terms of height and weight percentiles at the final visit. Finally, there were no differences in the growth pattern in the two birth cohorts. Conclusions: Our study points out that the final height in a coeliac child depends on genetic predisposition and time of puberal onset, more than on CD itself. Overall, coeliac patients show a final growth comparable to that of the healthy population.