The circulating insulin-like growth factor system in children with coeliacdisease: an additional marker for disease activity

Background Chronic undernutrition resulting from coeliac disease (CD) could be associated with changes in the circulating insulin-like growth factor ( IGF) system, which may participate in the pathogenesis of growth retardatio n occurring in these patients. Methods We performed a cross-sectional study in CD subjects attempting to ( 1) document the pattern of serum IGF-I and IGF binding protein (IGFBP) 1 an d 3 at diagnosis and (2) assess the response of circulating IGF system to d ietary treatments, in comparison with the response of clinical and laborato ry findings utilized for the diagnosis of CD. Thirty-two prepubertal CD chi ldren were divided into three groups based on the dietetic treatment: at di agnosis (D, n = 18); on gluten-free diet for at least 6 months (GFD, n = 7) , and on gluten challenge for at least 3 months (CEI, n = 7). Six postpuber tal CD patients were also studied at diagnosis; Results In prepubertal children IGF-1 levels were significantly reduced (by 29%) in D vs sex- and age-matched normal control (NC) subjects,with reduct ions being more pronounced before 3 years of age. Likewise, serum IGFBP-3 c oncentrations were decreased by 22%, whereas circulating IGFBP-1 levels wer e increased by 60%, compared with NC, with more marked IGFBP changes in old er children. Similar alterations were observed in postpubertal patients. Ch anges in the circulating IGF system disappeared in GFD subjects and reappea red in CH children, as positivity of disease-specific antibodies. Body mass index (BMI) also improved in GFD subjects, but did not decrease in CII chi ldren. Changes in IGF-I and IGFBPs did not correlate with each other. Level s of IGF-I, but not of IGFBPs, maintained the relation with age and correla ted significantly with BMI and positivity of antibodies. Conclusions These results demonstrate that CD patients show significant cha nges in serum IGF-I, in younger children, and IGFBPs (particularly IGFBP-1) , in older children and adolescents, correlating with clinical course and r esponse to dietary treatments. The alteration in the circulating IGF system could be implicated in the pathogenesis of growth retardation occurring in CD and may provide an additional tool in monitoring of the disease. Copyri ght (C) 1999 John Wiley & Sons, Ltd.