ASSESSMENT OF NUTRITIONAL STATUS AND DIETARY INTAKE PATTERNS OF CELIAC DISEASE PATIENTS (UNDER 5 YEARS): A CROSS SECTIONAL STUDY AT TERTIARY CARE UNITS OF DISTRICT PESHAWAR

Abstract

Introduction: Celiac disease (CD), caused by genetic predisposition and gluten exposure, is increasing globally and has a significant economic burden. Adherence  to a gluten-free diet can improve anthropometric measurements, but may not reach healthy levels. Limited studies on Pakistani young patients' dietary patterns or nutritional adequacy exist. The current study aimed at analyzing the nutritional status and dietary intake patterns of children under five children present with CD  in a tertiary care Unit at Peshawar 
Results: Most of the respondents (52.5%) belonged to rural areas. Females (62.5%)  were more affected from the disease as compared to males (37.5%). Most samples belonged to low socio-economic status (65.5%) having low parental income.  The  majority of samples had illiterate mothers (80.0%). Due to a high illiteracy rate most  mothers (90.0%) did not know about the disease. 22.5% samples had a family history  of disease. 67.5% did not known gluten-free foods. The majority (57.5%) of samples  belonged to the 1-2-year age group. The mean weight of 1-2 years male  (6.962±1.0609), female (6.787±1.0690), 2-3 years male (8.975±1.3769), female  (7.380±0.6099), 3-4 years male (10.500±0) and 4-5 years female (9.125±1.5478)  did not fall within the normal reference range of WHO. Z-score values (<-3) showed  that the samples were stunted. Biochemical parameters like tissue transglutaminase  IgA, IgG, haemoglobin and random blood sugar levels were not in agreement with the  reference values. About 87.5% samples were presented with diarrhoea, followed by  97.5% showing weight loss. 92.5% had dehydration, 97.5% had overall weakness,  97.5% had general fatigue. All samples (100%) had abdominal pain and irritable  behaviour. 95% samples had delayed growth. The majority of the samples suffered  from diabetes (32.5%), anaemia (32.5%) and hepatitis (27.5%). Consumption of  gluten-rich sources such as roti, biscuits, cakes and starting complementary feeding  with roti was highest. The intake of fruits and vegetables was less. Intake of tea  and green tea was high. Overall, the children had clinical symptoms of  micronutrient deficiencies along with being severely wasted and stunted.   
Conclusions: The current study concludes that children under five years were severely malnourished.  Patients with lower incomes have worse CD-related health and greater symptoms. The mass illiteracy among mothers and lack of knowledge about the disease and gluten-free foods emphasize the serious need for Maternal  education that influences various factors such as access to healthcare, knowledge of dietary needs, and overall family health practices