Anti-tissue transglutaminase IgA levels in severe acute malnutrition in children up to 60 months of age-a cross-sectional study from North-West India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20252220Keywords:
Anti-tissue transglutaminase, Severe acute malnutrition, Celiac diseaseAbstract
Background: To evaluate anti-tissue transglutaminase IgA (anti-tTG IgA) levels among children suffering from severe acute malnutrition (SAM) aged up to 60 months.
Methods: This observational study was conducted at Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. A total of 100 children diagnosed with SAM, meeting the inclusion criteria, were enrolled. Following thorough clinical assessment and management as per standard protocols, their anti-tTG IgA levels were measured.
Results: Elevated anti-tTG IgA levels (>4 U/ml) were observed in 37% of participants. Among them, 21% showed weakly positive results while 16% had strongly positive levels.
Conclusion: Screening for celiac disease using anti-tTG IgA levels in SAM patients with persistent gastrointestinal symptoms is crucial. For children with levels exceeding 10 U/ml, further diagnostic procedures like intestinal biopsy are recommended to facilitate timely diagnosis and intervention.
Metrics
References
WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization. 2013.
World Health Organization (WHO). Guidelines for the Inpatient Treatment of Severely Malnourished Children. World Health Organization (WHO). 2003.
Reilly N, Green PR. Presentation of celiac disease in children and adults. In: Rampertab SD, Mullin GE, editors. Celiac disease. New York: Springer. 2014: 95–105. DOI: https://doi.org/10.1007/978-1-4614-8560-5_8
Branski D, Troncone R, Fasano. Celiac disease. In: Kliegman R, Stanton B, Geme St J, Schor N, editors. Nelson textbook of pediatrics. Reed Elseveier India Pvt Ltd. 2015;2:1835–6.
Brunetta P, Fabio F, Carla V and Lucia T. Assessment of a test for the screening and diagnosis of celiac disease. J Clin Labor Analy. 2016;30:65–70. DOI: https://doi.org/10.1002/jcla.21816
Tonutti E, Visentini D, Bizzaro N. The role of anti-tissue transglutaminase assay for the diagnosis and monitoring of coeliac disease: A French-Italian multicentre study. J Clin Pathol. 2003;56:389–93. DOI: https://doi.org/10.1136/jcp.56.5.389
Korponay-Szabo IR, Dahlbom I, Laurila J. Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for celiac disease in selective IgA deficiency. Gut 2003;52:1567–71. DOI: https://doi.org/10.1136/gut.52.11.1567
Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. J Pediatr Gastroenterol Nutr. 2012;54(1):136-60. DOI: https://doi.org/10.1097/MPG.0b013e31821a23d0
Deora NS, Deswal A, Dwivedi M, Mishra HN. Prevalence of coeliac disease in India: a mini review. Int J Latest Res Sci Technol. 2014;3:58–60.
WHO. Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organisation and the United Nations Children's Fund Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press. 2019.
Harrison MS, Wehbi M, Obideen K: Celiac disease: More common than you think. Cleve Clinic J Med. 2007;74:209-215. DOI: https://doi.org/10.3949/ccjm.74.3.209
Bhadoria AS, Kapil U, Bansal R, Pandey RM, Pant B, and Mohan A. Prevalence of severe acute malnutrition and associated sociodemographic factors among children aged 6 months–5 years in rural population of Northern India: A population-based survey. J Family Med Prim Care. 2017;6(2):380–5. DOI: https://doi.org/10.4103/jfmpc.jfmpc_421_16
Shewade HD, Sunderamurthy B, Jayakumar N, Ramadoss P. Prevalence of severe acute malnutrition (SAM) among under-five children: A community-based cross-sectional study from Puducherry India. Indian J Matern Child Health. 2013;15:1–7.
Pravana NK, Piryani S, Chaurasiya SP, Kawan R, Thapa RK, Shrestha S. Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case-control study. BMJ Open. 2017;7(8):17084. DOI: https://doi.org/10.1136/bmjopen-2017-017084
Prashanth MR, Savitha MR, Prashantha B. Risk factors for severe acute malnutrition in under- five children attending nutritional rehabilitation center of tertiary teaching hospital in Karnataka: a case control study. Int J Contemp Pediatr. 2017;4(5):1721-6. DOI: https://doi.org/10.18203/2349-3291.ijcp20173773
Sahoo DP, Dehmubed A, Jajulwar MB. An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra. J Datta Meghe Inst Med Sci Univ. 2017;12:181-6. DOI: https://doi.org/10.4103/jdmimsu.jdmimsu_31_17
Mehta S. vitamin d levels among children with severe acute malnutrition. World J Pharma Res. 2017;6(5):781-5. DOI: https://doi.org/10.20959/wjpr20175-8334
Sharma M, Mandot S. Prevalence and clinical profile of celiac disease among malnourished children in South Rajasthan, India. Int J Contemp Pediatr. 2018;5:997- 1002. DOI: https://doi.org/10.18203/2349-3291.ijcp20181529
Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63:1210-28. DOI: https://doi.org/10.1136/gutjnl-2013-306578
Thapa. Celiac disease in chidren: Recent Concepts. JK Sci. 2010;3:3-12.
Kulkarni B, Mamidi RS. Nutrition rehabilitation of children with severe acute malnutrition: Revisiting studies undertaken by the National Institute of Nutrition. Indian J Med Res. 2019;150:139-52. DOI: https://doi.org/10.4103/ijmr.IJMR_1905_18
Dwivedi SN, Banerjee N, Yadav OP. Malnutrition among children in an urban Indian slum and its associations. Indian J Matern Child Health. 1992;3:79-81.
Avachat SS, Phalke VD, Phalke DB, Aarif SM, Kalakoti P. A cross-sectional study of socio- demographic determinants of recurrent diarrhoea among children under five of rural area of Western Maharashtra, India. Australas Med J. 2011;4:72-5. DOI: https://doi.org/10.4066/AMJ.2011.524
Beniwal N, Ameta G, Chahar CK. Celiac disease in children with severe acute malnutrition (SAM): a hospital-based study; Indian J Pediatr. 2017:(84):339–43. DOI: https://doi.org/10.1007/s12098-017-2300-x