Serum FGF-21 levels and stature in children and adolescents with celiac disease on a gluten-free diet

Abstract

OBJECTIVES: To evaluate stature in patients with celiac disease (CD) adherent to a gluten-free diet (GFD), determine the prevalence of growth hormone deficiency (GHD), and assess the associations between stature and serum insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein 3 (IGFBP-3), and FGF 21 levels. METHODS: In this prospective cross-sectional study, 141 pediatric patients with CD (79 females) who had adhered to a GFD for at least 2 years were included. Anthropometric and clinical data were obtained from medical records. Serum IGF-1, IGFBP-3, and FGF21 levels were measured in fasting samples. Growth hormone stimulation tests (L-dopa and clonidine) were performed in patients with a height >1.5 SDS below target height (TH). RESULTS: Twelve patients (8.5 %) had persistent short stature despite long-term adherence to a GFD. Growth hormone deficiency was diagnosed in three patients (2.1 % of the entire cohort; 25 % of patients with persistent short stature). Patients with persistent short stature without GHD had significantly lower serum IGF-1 and IGFBP-3 standard deviation scores than those with normal stature, whereas serum FGF21 concentrations did not differ significantly between the groups. Serum FGF21 concentrations were not significantly correlated with height SDS, IGF-1, IGFBP-3, or other anthropometric variables. CONCLUSIONS: Persistent short stature may occur despite long-term adherence to a GFD in a small proportion of children and adolescents with CD. GHD was identified in 2.1 % of patients, emphasizing the importance of growth monitoring. Lower IGF-1 and IGFBP-3 SDS in patients with persistent short stature without GHD suggest alterations within the GH-IGF axis. Serum FGF21 concentrations were not associated with stature, suggesting that persistent growth impairment in treated CD is likely multifactorial and is not explained by circulating FGF21 alone.