Serum FGF-21 levels and stature in children and adolescents with celiac disease on a gluten-free diet

Abstract Objectives To evaluate stature in patients with celiac disease (CD) adherent to a gluten-free diet (GFD), determine the prevalence of growth hormone deficiency (GHD), and assess the associations between stature and serum insulin-like growth factor-1 (IGF-1), insulin-like growth factor–binding protein 3 (IGFBP-3), and FGF 21 levels. Methods In this prospective cross-sectional study, 141 pediatric patients with CD (79 females) who had adhered to a GFD for at least 2 years were included. Anthropometric and clinical data were obtained from medical records. Serum IGF-1, IGFBP-3, and FGF21 levels were measured in fasting samples. Growth hormone stimulation tests (L-dopa and clonidine) were performed in patients with a height >1.5 SDS below target height (TH). Results Twelve patients (8.5 %) had persistent short stature despite long-term adherence to a GFD. Growth hormone deficiency was diagnosed in three patients (2.1 % of the entire cohort; 25 % of patients with persistent short stature). Patients with persistent short stature without GHD had significantly lower serum IGF-1 and IGFBP-3 standard deviation scores than those with normal stature, whereas serum FGF21 concentrations did not differ significantly between the groups. Serum FGF21 concentrations were not significantly correlated with height SDS, IGF-1, IGFBP-3, or other anthropometric variables. Conclusions Persistent short stature may occur despite long-term adherence to a GFD in a small proportion of children and adolescents with CD. GHD was identified in 2.1 % of patients, emphasizing the importance of growth monitoring. Lower IGF-1 and IGFBP-3 SDS in patients with persistent short stature without GHD suggest alterations within the GH–IGF axis. Serum FGF21 concentrations were not associated with stature, suggesting that persistent growth impairment in treated CD is likely multifactorial and is not explained by circulating FGF21 alone.