Bayrak Nevzat Aykut, Volkan Burcu, Haliloglu Belma, Kara Soner Sertan, Cayir Atilla
Zeynep Kamil Women and Children's Hospital, Department of Pediatric Gastroenterology, Istanbul, Turkey.
Pediatric Gastroenterology, Hepatology and Nutrition, Diyarbakir Children's Hospital, Diyarbakir, Turkey.
J Pediatr Endocrinol Metab. 2020 Mar 26;33(3):409-415. doi: 10.1515/jpem-2019-0378.
Objectives We aimed to assess whether age at menarche and pubertal development (Tanner stage) are related to gluten-free diet (GFD) adherence, hormonal status, micro-nutrient levels and body mass index (BMI) in children with celiac disease (CD). Methods In this two-center, cross-sectional study, CD patients and healthy individuals were studied. CD patients were re-evaluated after 1 year of follow-up. Height, weight, Tanner stage, age at menarche and diet compliance were recorded. Blood samples for anti-tissue transglutaminase IgA (TTG), pituitary gonadotropins, gonadal hormones, prolactin and micronutrients (folate, vitamin B12, vitamin D, ferritin, iron and, iron-binding capacity [IBC]) were assayed. Results Consecutive age- and sex-matched 228 celiac patients (12.92 ± 2.35 years; 67.9% female) and 135 non-celiac healthy individuals (12.77 ± 2.25 years; 65.2% female) were studied. Tanner stage was significantly higher in the control group for both girls and boys (p < 0.05). The mean age at menarche was significantly lower in healthy individuals (13.13 ± 1.01 vs. 12.15 ± 0.97, p < 0.001). By multivariate analysis, GFD adherence, transferrin saturation (sTrf), total IBC (TIBC) and vitamin D status were found to be positively correlated with Tanner stage (p < 0.05). After 1 year, 192 of the CD patients were re-evaluated. GFD compliance was better (TTG levels: 135.59 ± 73.88 vs. 71.53 ± 69.40, p < 0.001) and it was correlated with Tanner stage (r = 0.49, p < 0.01), sTrf (r = 0.66, p < 0.01) and IBC (r = 0.23, p < 0.05). Conclusions Our data show that adequate weight gain, adherence to GFD, sufficient iron and vitamin D status are essential factors for salubrious puberty in CD patients.
目的 我们旨在评估初潮年龄和青春期发育（坦纳分期）是否与乳糜泻（CD）患儿的无麸质饮食（GFD）依从性、激素状态、微量营养素水平及体重指数（BMI）相关。方法 在这项双中心横断面研究中，对CD患者和健康个体进行了研究。CD患者在随访1年后重新进行评估。记录身高、体重、坦纳分期、初潮年龄和饮食依从性。检测抗组织转谷氨酰胺酶IgA（TTG）、垂体促性腺激素、性腺激素、催乳素和微量营养素（叶酸、维生素B12、维生素D、铁蛋白、铁及铁结合能力[IBC]）的血样。结果 对连续入选的228例年龄和性别匹配的乳糜泻患者（12.92±2.35岁；67.9%为女性）和135例非乳糜泻健康个体（12.77±2.25岁；65.2%为女性）进行了研究。对照组中女孩和男孩的坦纳分期均显著更高（p<0.05）。健康个体的平均初潮年龄显著更低（13.13±1.01 vs. 12.15±0.97，p<0.001）。通过多变量分析，发现GFD依从性、转铁蛋白饱和度（sTrf）、总IBC（TIBC）和维生素D状态与坦纳分期呈正相关（p<0.05）。1年后，对192例CD患者进行了重新评估。GFD依从性更好（TTG水平：135.59±73.88 vs. 71.53±69.40，p<0.001），且与坦纳分期（r=0.49，p<0.01）、sTrf（r=0.66，p<0.01）和IBC（r=0.23，p<0.05）相关。结论 我们的数据表明，体重适度增加、坚持GFD、充足的铁和维生素D状态是CD患者青春期健康发育的重要因素。
