Welcome to the ESPGHAN 2023 Interactive Programme
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ESGE Session - 
GLUTEN-FREE DIET: ESPGHAN POSITION PAPER 2023. (ID 1591)
G-O002 - ASSOCIATIONS OF ADHERENCE TO DIETARY PATTERNS THE FIRST 2 YEARS OF LIFE WITH RISK OF CELIAC DISEASE AUTOIMMUNITY AND CELIAC DISEASE AMONG HIGH-RISK CHILDREN. (ID 83)
Abstract
Objectives and Study
To explore associations of adherence to dietary patterns up to age 2 years with risk of celiac disease autoimmunity (CDA) and celiac disease (CeD).
Methods
Data were retrieved from 6,677 participants enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study, a longitudinal observational birth cohort with a 15-year follow-up on type 1 diabetes and CeD. Children were annually screened for tissue transglutaminase autoantibodies (tTGA) from age 2 years. Dietary patterns were based on intake of 27 food groups assessed by 22,410 3-day food records from age of 9 to 24 months. The primary outcome, CDA, was defined as being persistently tTGA positive confirmed in at least 2 consecutive samples. The secondary outcome, CeD, was defined as an intestinal biopsy showing Marsh >2 or having a mean level of tTGA >100 units if a biopsy was not performed. Associations of adherence to dietary patterns with the study outcomes were estimated by Cox regression models adjusted for daily gluten intake.
Results
A total of 1287 (19.3%) children developed CDA and 527 (7.9%) CeD during follow-up to mean age 11.0 years (SD 3.6). At age 9 months, a dietary pattern high in vegetable fats and milk, and low in infant formula and breastmilk was associated with reduced risk of CDA (HR 0.88, 95% CI [0.81, 0.99], P=.04, per 5-unit increase). A dietary pattern high in wheat, vegetable fats, and juices, and low in milk, meat, and oats at age 24 months, was associated with increased risk of CDA (HR 1.18, 95% CI [1.05, 1.33], P<.001) and CeD (HR 1.24, 95% CI [1.03, 1.50], P=.03, per 5-unit increase).
Conclusions
Associations between dietary patterns in the first 2 years of life and risk of CDA and CeD indicate that additional dietary factors besides the gluten amount impact disease risk in genetically predisposed children.
PERSISTENT SYMPTOMS INSPITE OF GLUTEN-FREE DIET. (ID 1592)
G-O004 - EVALUATION OF GLUTEN-FREE DIET COMPLIANCE OF CHILDREN WITH COELIAC DISEASE BY URINE AND FECAL GLUTEN IMMUNOGENIC PEPTIDES (ID 792)
Abstract
Objectives and Study
There is still no evidence-based recommendation for assessing adherence to a gluten-free diet (GFD) in coeliac disease (CD). Gluten immunogenic peptides (GIP) in stool and urine indicate minimal and recent gluten exposure (stool GIP: last 2-7 days; urine GIP: last 1-2 days). In this study, we aimed to evaluate GFD adherence in children with CD by using urine and fecal GIP together.
Methods
Children with CD (3-18 years old) who have been on GFD for >12 months were enrolled. Clinical and nutritional assessments and serologic results were noted. ‘Good dietary adherence’ plus ‘never having voluntary transgressions’ was defined as adherence to GFD. IVYLISA GIP-Stool test (ELISA) and IVYCHECK GIP-Urine test (immunochromatography)(Biomedal S.L,Seville,Spain) were used. The relationship of these biomarkers with serology, overall dietary adherence, and GFD compliance in the last 2 and 7 days was investigated.
Results
Of 119 patients, 65% were girls. The mean GFD duration was 6±3.7 years. Serology was positive in 39.5%. Urine and stool GIP were positive in 18.5% (n=22) and 11.8% (n=14), respectively. The positive stool GIP group showed a higher ratio of urine GIP positivity when compared with the negative stool GIP group (p=0.004). A significant relationship was found between positive serology and non-adherence to GFD (p=0.007). Ratios of urine GIP (p=0.001) and stool GIP (p=0.041) positivity were higher in the non-adherence to GFD group. The GFD adherence in the last 2 days and 7 days of study enrollment was associated with negative serology (p=0.021 and p=0.011), negative stool GIP (p=0.003 and p=0.004), and negative urine GIP (p=0.003 and p <0.001). No significant relationship was shown between positive serology and stool and urine GIP positivity.
Conclusions
This is the first paediatric study evaluating fecal and urine GIP together. Fecal and urine GIP are helpful in routine clinical practice in detecting recent dietary transgressions, especially when used together.
DOES SERONEGATIVE COELIAC DISEASE EXIST? (ID 1593)
G-O003 - LONG-TERM COST-EFFECTIVENESS OF ACTIVE CASE-FINDING FOR COELIAC DISEASE IN CHILDREN IN THE NETHERLANDS (ID 532)
Abstract
Objectives and Study
A cost-utility analysis was conducted to assess the long-term cost-effectiveness of various case-finding strategies (vs. standard care) for detecting coeliac disease (CD) in children at Dutch Preventive Youth Health Care Centers.
Methods
The cost-effectiveness of various case-finding strategies was modelled using decision trees and a Markov model over the average lifespan of individuals, assuming children were aged two at testing. The competing strategies differed in the selection criteria applied before testing (i.e. from mass-screening to testing only highly symptomatic children). The development of long-term consequences (e.g. iron-deficiency anemia, osteoporosis, gastrointestinal cancer) and the chance of being clinically detected were modeled as annual probabilities based on available literature/data. Costs and quality-of-life measures associated with being (un)diagnosed with CD and developing long-term consequences were sourced from literature and data reported by 2,700 members of the Dutch Coeliac Society. Other model parameters were derived from data gathered during the GLUTENSCREEN project, where case-finding was implemented at Dutch Preventive Youth Health Centers (www.glutenscreen.nl).
Results
At the commonly-applied willingness-to-pay threshold of €20,000 per quality-adjusted life-year (QALY) for prevention interventions, every strategy had a >95% probability of being cost-effective compared to standard care. The most cost-effective strategy was mass-screening regardless of symptoms. The improved cost-effectiveness of the strategies compared to standard care was largely driven by the QALY gains associated with spending more time in the diagnosed health states. Cost differences between all strategies were not large, in part because the increased costs of being undiagnosed (and developing long-term consequences) offset some of the costs of following a gluten-free diet after diagnosis.
Conclusions
Given the outcome of the cost-effectiveness analysis, the preferred strategy was mass-screening, which may also be easier to implement/integrate into regular pediatric care.