symptoms of failure to thrive and malnutrition . Also , 22 % of our study population was either overweight or obese . While historically CD was associated with malnutrition and poor growth , current research has demonstrated that 9 – 20 % of adult and pediatric patients with CD are overweight and 0 – 6 % of patients are obese depending on the study design , weight status definitions , and patient population . 24 The coexistence of CD and obesity is of special relevance to WV , with 22 % of children ( 10-17 years ) in WV being obese in 2019-2020 , higher than the national rate of 16 %. 25 Additionally , WV has the second highest rate of food insecurity in the nation , 26 and individuals with CD are less likely to adhere to GFD if food is insecure . 27 The high cost of GFD foods can create economic burdens for patients with CD especially those in low-income households preventing the adoption and continued GFD use . Financial support for GFD groceries and connecting patients to local GFD resources may increase diet adherence .
CONCLUSION
Our data fills in the gap of the paucity of information available about CD in children from Appalachia . Based on our study , regional characteristics of CD aligned with non-classical and varied presentation , a recent trend seen globally . A high index of suspicion should be utilized to screen and diagnose CD as the majority of patients can be either asymptomatic or lack classic findings . GFD is highly effective although proper follow-up after initial diagnosis remains a challenge .
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TABLE 4 : Serology Testing Results at Diagnosis and Follow-Up
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Tissue Transglutaminase ( tTG ) antibodies , IgG
Deaminated gliadin peptide ( DGP ) antibodies , IgA
Deaminated gliadin peptide ( DGP ) antibodies , IgG
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Percent of Patients Having Positive Antibody Levels at Follow-Up
Percent of Patients Having Improvement in Antibody Level Since Diagnosis
n = 59 n = 49 n = 49
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88 % 24 % 94 % Endomysial antibodies , IgA 70 % 25 % N / A
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24 • www . wvsma . org