Researchers in the Netherlands have made a startling suggestion: children with celiac disease might not need to start a gluten-free diet until they begin to develop symptoms.
Celiac disease, which can cause stomach cramping, pain, bloating, diarrhea, and weight loss, is caused by allergy to gluten, mainly found in wheat.
How the study was done
Researchers, led by Dr. Maria Louisa Marin of Leiden University Medical Center, followed 32 children who were diagnosed with celiac disease when they were between the ages of 2 and 4, during a mass screening effort in 1998. A total of 26 children (81 percent) were treated with a gluten-free diet, either immediately after screening or at some later point.
In the journal Pediatrics, the researchers report that at 10 years after diagnosis, "The health status improved in 66 percent of the treated children: in 41 percent by early treatment and in 25 percent by prevention of gluten-dependent symptoms that they developed after diagnosis."
The researchers also point out that, at diagnosis, the children with symptoms had low health-related quality of life compared to a reference population of Dutch children. By 10 years, the health-related quality of life of the children with celiac disease who adhered to the gluten-free diet was no different to that of the reference population.
What the study found
Of the 6 children who continued to eat gluten, the investigators report, "treatment after screening would not have improved their health status, because they had no symptoms at screening and have remained symptom-free while consuming gluten."
The investigators conclude that "in a research setting," continuing to eat gluten "seems to be an option" for symptom-free children with celiac disease. They stop short of recommending it routinely, however.
"Although our study has a relatively long follow-up, 10 years is still a short period of time to assess possible long-term complications in untreated celiac disease," they admit, "and long-term follow-up studies are needed to provide sound advice." - (Reuters Health)
SOURCE: Pediatrics, April 2009.