Iron Deficiency Anemia Among Pediatric Celiac Disease Patients at the Armed Forces Hospital Southern Region: Prevalence, Predictors, and Outcomes

Background Celiac disease (CD) is a common immune-mediated enteropathy in children and is frequently associated with iron deficiency anemia (IDA), which may be an initial or prominent extraintestinal manifestation and, in some cases, the presenting feature of the disease. While IDA is well recognized in pediatric CD, data regarding its prevalence, clinical correlates, and longitudinal outcomes in children from southern Saudi Arabia remain limited, particularly in tertiary care settings. Objectives The primary objective was to determine the prevalence of IDA at the time of CD diagnosis in children. The secondary objectives were to assess the persistence of IDA at one and two years following initiation of a gluten-free diet and to evaluate demographic, clinical, and treatment-related factors associated with its presence and persistence. Methods A retrospective cohort study was conducted at the Armed Forces Hospital - Southern Region, including children and adolescents aged 1-18 years with confirmed CD diagnosed between January 2016 and December 2023. Demographic characteristics, clinical presentation, diagnostic modality, iron therapy details, and hematologic outcomes were extracted from medical records. Associations between patient characteristics and IDA were analyzed using univariable and multivariable logistic regression models. Results Ninety-seven children with CD were included, of whom 59 (60.8%) were females. IDA was present at diagnosis in 25 (25.8%) patients. No statistically significant associations were identified between IDA and age at diagnosis, gender, short stature, poor weight gain, or syndromic status. Most patients did not require iron supplementation; among those treated, oral iron was administered once daily for three months, typically using standard pediatric weight-based dosing (approximately 3-6 mg/kg/day of elemental iron). Resolution of IDA occurred in 68.0% of affected children at one year following gluten-free diet initiation and increased to 88.0% by two years. Multivariable analyses demonstrated no significant predictors for either the presence of IDA at diagnosis or its persistence at one-year follow-up. Conclusions IDA affected approximately one quarter of children at the time of CD diagnosis in this cohort; however, given the high background prevalence of nutritional iron deficiency in pediatric populations, anemia cannot be attributed exclusively to CD in all cases. The majority of affected children demonstrated hematologic recovery following adherence to a gluten-free diet, with progressive improvement over time, supporting a disease-related contribution in a substantial proportion of patients. No demographic, clinical, or treatment-related factors were independently associated with either the presence or persistence of anemia. These findings underscore the importance of routine anemia screening at diagnosis and continued hematologic monitoring during follow-up in children with CD.