ABSTRACT Short stature is the most common extraintestinal feature of celiac disease (CD) and may be the only symptom of the disease. In fact, in evaluating a short child, the first step is usually the exclusion of CD as it may be responsible for growth failure. Once the diagnosis of CD has been made, the introduction of a gluten-free diet (GFD) increases the intestinal absorption of both macro and micronutrients leading to improved height and weight in celiac children with malabsorption. The pathogenesis of the growth failure is yet unclear. The various presentations of CD create a clinical challenge to clinicians in reaching an early diagnosis. Undiagnosed CD can lead to infertility, osteoporosis and malignancy. Adherence to GFD can limit the risk for adverse clinical outcomes but some nutritional imbalances in the diet of celiac children have been noted. In celiac patients treated with GFD, significant catch-up growth is generally observed with a recovery of growth pattern. On the other hand, an endocrinological investigation including an evaluation of growth hormone (GH) secretion should be performed in celiac children who show no catch-up growth after at least one year on a strict GFD when seronegativity for antibodies anti-transglutaminase and anti-endomysium is confirmed. At the same time, it is very important to carry out nutrition education sessions during the follow-up of celiac children because it is necessary, in addition to the elimination of gluten, to evaluate the overall diet and improve the quality of the celiac diet in order to achieve optimal health. The effect of a gluten-free diet on growth should be evaluated mainly in biopsy-proven celiac patients who show a poor response to growth despite strict adherence to dietary restrictions.
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