Suggested screening for nutritional deficiencies and other comorbidities in children with celiac disease

Screening test	At diagnosis of celiac disease	Follow-up*
Height, weight, and BMI	Yes	Yes
tTG-IgA antibodies	Yes	Yes
CBC	Yes	Yes
Ferritin, iron, TIBC	Yes	PRN
Vitamin D	Yes	PRN
Calcium, phosphorus, alkaline phosphatase, PTH	PRN	PRN
DXA	PRN	PRN^¶
Folate	PRN	PRN
Other vitamins, zinc, and trace elements	PRN	PRN
ALT, AST	Yes	PRN
Diabetes screening (serum glucose, A1C, symptom counseling)	PRN	PRN
TSH^Δ	Yes	Yes
HBsAb	PRN^◊	PRN

Recommended approaches to laboratory screening for pediatric patients with celiac disease, based on review of the evidence and voting by a consensus panel. "Yes" indicates a recommendation for routine screening in all patients (bold denotes a strong recommendation); PRN indicates a recommendation for testing only in selected patients, based on individual risk factors, clinical signs or symptoms, or prior test results.

BMI: body mass index; tTG-IgA: immunoglobulin A antibodies to tissue transglutaminase; CBC: complete blood count; TIBC: total iron-binding capacity; PTH: parathyroid hormone; DXA: dual-energy x-ray absorptiometry; ALT: alanine aminotransferase; AST: aspartate aminotransferase; A1C: hemoglobin A1c; TSH: thyroid-stimulating hormone; HBsAb: hepatitis B s antibody; HBV: hepatitis B virus.

* Follow-up testing is typically done approximately 6 months after beginning a gluten-free diet. For patients whose serologies become negative, we repeat testing annually.

¶ DXA screening is suggested for patients who do not adhere to a gluten-free diet.

Δ Testing for antithyroid antibodies was not recommended, except as follow-up testing for patients with abnormal TSH.

◊ Individuals with celiac disease are not athigher risk of nonresponse than is the general population and, moreimportantly, are not at higher risk of HBV infection^[1]. However, some clinicians still perform serologic screening to determine the hepatitis B immune status.

Reference:

Habash N, Choung RS, Jacobson RM, et al. Celiac Disease: Risk of Hepatitis B Infection. J Pediatr Gastroenterol Nutr 2022; 74:328.

Based on recommendations by an expert panel, in: Snyder J, Butzner JD, DeFelice AR, et al. Evidence-Informed Expert Recommendations for the Management of Celiac Disease in Children. Pediatrics 2016; 138.

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Suggested screening for nutritional deficiencies and other comorbidities in children with celiac disease