LAUSR

Background Celiac disease(CD) is a common, often neglected health care problem with avoidable mortality and morbidity in the Indian population with a prevalence of 0.9 to 1%. We studied the effect of gluten-free diet(GFD) on nutrition of newly diagnosed children in our population where multiple causes of malabsorption coexist. We also aimed at formulating an optimum follow up schedule according to the expected change in nutritional parameters and avoid unnecessary hospital visits and blood investigations Methods 51 children with no known chronic disorder, between 1 - 10 years, diagnosed with CD were enrolled. Samples were drawn for hemoglobin, Ferritin, Proteins, Albumin, lipid and amino acid profile at enrollment. GFD was introduced with diet charts and counselling sessions. Children were followed up at 1,3 and 6 months. Change in biochemistry at the end of 6 months was analyzed Results In our study the mean age of presentation was 74 months, youngest being 19 months old. 50.9% of the patients had classic malabsorptive symptoms, 25% had refractory anemia, 13% short stature and11% were diagnosed on sibling screen. Notable associations included Autism spectrum disorder, enamel hypoplasia and atopy. At presentation, 84% of patients were anemic, 9.85% were severely anemic. After 6 months of treatment none had severe anemia(<8g/dl), though 74% remained anemic with a significant change( p= 0.045). Significant improvement in ferritin( p =0.0001), protein ( p =0.002) and HDL levels ( 0.02) was observed. We observed significant (p= 0.006) increase in citrulline, fall in alanine (p<0.0005), valine (p<0.0005), proline (p =0.0005) and lysine (p=0.004) levels during follow up as shown in figure 1(figure.1).Abstract IDDF2019-ABS-0015 Figure 1 Amino acid profile Conclusions Significant Improvement in anemia and ferritin levels on the basis of dietary modification alone emphasizes the role of intestinal malabsorption in children with CD. Change in Protein and HDL levels signify cardioprotective role of GFD in celiacs with deranged lipid profile. Marginal though a significant rise in plasma citrulline levels strongly supports citrulline’s role as a marker of enterocyte mass recovery in CD. We conclude that it takes at least 6 months of GFD to show significant improvement in nutritional parameters in children with celiac disease and follow up should be planned accordingly.