Body composition in pediatric celiac disease and metabolic syndrome component risk—an observational study

Background: Celiac disease (CD) in children and adolescents has been linked with increased susceptibility for cardiometabolic disease in adulthood. We explored the interaction between body composition and metabolic syndrome (MetS) components in pediatric CD. Methods: We conducted a retrospective observational study of patients with CD followed at our Pediatric Endocrine and Gastroenterology Units between 1/2018-1/2022. Data on sociodemographic, clinical, laboratory, and body composition parameters (bioelectrical impedance analysis, BIA) were collected. Results: Forty-four patients with MetS components and 67 patients without them were enrolled. The cohort’s mean age at BIA assessment was 11.5 ± 3.6 years. Individuals with MetS components were older (P = 0.045), had higher BMI z-scores (P < 0.001), higher total and truncal fat percentage levels (P < 0.001), lower muscle-to-fat ratio z-scores (P = 0.018), higher sarcopenic indices (P = 0.05), higher systolic blood pressure percentiles (P = 0.001), higher triglycerides levels (P = 0.009), and higher triglycerides/HDL-c ratios (P < 0.001) than those without MetS components. A sex- and age-adjusted model revealed that the diagnosis of MetS components was positively associated with fat percentage (odds ratio = 1.087, confidence interval [1.010–1.171], P = 0.027), but not with BMI z-scores (P = 0.138). Conclusions: We found that fat percentage but not weight status is associated with risk for MetS components in individuals with childhood-onset CD. Preventive interventions should target an improvement in body composition. Impact: The literature on cardiometabolic risk in pediatric patients with celiac disease (CD) is sparse.Our analysis revealed that at least one metabolic syndrome (MetS) component was present in two out of every five children and adolescents with CD.An increase in fat percentage but not in body mass index z-scores predicted the presence of MetS components in our cohort.These findings suggest that the weight status of children and adolescents with CD does not mirror their risk for MetS components.Body composition analysis should be considered as an integral part of the clinical evaluation in young patients with CD.