Undiagnosed Celiac Disease Linked to Unexplained Behavioral Problems in Kids

By Megan Brooks

September 13, 2019

NEW YORK (Reuters Health) - Subclinical celiac disease autoimmunity (CDA) is associated with anxiety and oppositional defiant behavior in children without a formal diagnosis of celiac disease, new research indicates.

Celiac disease is associated with emotional and behavioral problems in children, but whether this association is already present in children with subclinical celiac disease identified by screening has been unclear, the study team notes in Pediatrics, online September 6.

Dr. Jessica Kiefte-de Jong from Leiden University Medical Center in the Netherlands and colleagues did a population-based study of 3,715 children (median age, 6 years), excluding those with diagnosed celiac disease or on a gluten-free diet. Parents completed the Child Behavior Checklist (CBCL).

Fifty-one children (1.4%) had CDA based on tissue transglutaminase autoantibody (TGA) titers at or above 7 U/mL. Most of them (92%) carried the HLA-DQ2 or HLA-DQ8 risk allele.

CDA was significantly associated with anxiety (beta=0.29; P=0.02) after adjusting for ethnicity, maternal income and maternal education level. The association was stronger in children with CDA carrying the HLA-DQ2 and/or HLA-DQ8 risk allele (beta=0.31; P=0.01).

CDA was also associated with oppositional defiant problems (beta=0.35; P=0.02) and aggressive behavior (beta=0.32; P=0.05) in the subgroup carrying the HLA-DQ2 and/or HLA-DQ8 allele.

These associations were not explained by gastrointestinal complaints.

"I hope that clinicians become more aware that certain unexplained behavioral problems may be a reflection of undiagnosed celiac disease in children," Dr. Kiefte-de Jong told Reuters Health by email. "However, further study is needed to evaluate whether it is (cost-)effective to screen all children with unexplained psychological problems for CDA because many other factors (including the social environment) can cause behavioral problems in children."

Because psychological symptoms may improve with a gluten-free diet, "early diagnosis and treatment of celiac disease could prevent further development or deterioration of psychopathology in these children," the researchers note in their paper.

However, further research is needed to evaluate whether behavioral problems can be improved by a gluten-free diet in children with CDA identified by screening, they say.

In an editorial published with the study, Dr. Laura Smith of the University of South Florida in Tampa and co-authors say these findings "provide additional support for the relevance of addressing CDA and celiac disease early in life to improve not only physical but also psychological functioning."

Pediatric healthcare providers, they add, "should be cognizant of the potential emotional and behavioral manifestations of celiac disease and should consider TGA screening for children presenting with these types of psychological or behavioral complaints."

SOURCE: https://bit.ly/2kvgPap and https://bit.ly/2k6xile

Pediatrics 2019.