December 28, 2020

Celiac in India: Masquerading with Malnutrition

Good Nutrition (more specifically a Balanced Diet) is integral for a healthy community and the well-being of all in a family, especially children. Malnutrition has no boundaries and has grasped all the continents for centuries.Plagued by social, economic and political events the issue of Malnutrition spiked in the 20th century. It became more chronic in the developing world. As the children are mostly dependent on mothers they are more vulnerable to malnutrition if the food distribution is not even.

Severe malnutrition happens if there is food scarcity at household levels, inappropriate feeding practices, poor absorption of nutrients in diseases like Celiac disease, poor appetite and increased requirements in diseases like TB etc. The ancient Greeks were the first to report the occurrence of severe intolerance of gluten which was later coined as Celiac Disease referring to the autoimmune disorder of the intestines caused by consumption of this protein. Not only gluten damages the intestinal mucosa, but also if coupled with malnutrition it results in severe complications like retarded body growth, liver disease, osteoporosis and other autoimmune conditions. Malnutrition is classified intothree categories: Underweight (it’s a composite indicator denoting chronic oracute malnutrition), Stunting (indicating retarded straight growth due to inadequate nutrition and/or comorbidities) and Wasting (designating thepresence of acute illness due to lack of proper nutrition over a large span of time).

Multiple studies of the Indian population and among the children have deciphered analarming scenario of the comorbidity of malnutrition and Celiac disease prevailing in the country. In last two decades celiac disease has been increasingly reported from various north Indian centers. Around 26%-49% of Indian children presenting with chronic diarrhea, are diagnosed with Celiac Disease in tertiary care hospitals. The children of North India are more susceptible to the complications as in from other regions due to their dependence on wheat as major food source. There is a long way to recovery as the rate of screening is very dismal and due to lack of awareness on celiac as it’s not diagnosed on time. The diagnostic protocol for Celiac Serology comprises of Antiendomysial antibody (EMA) test, Tissue transglutaminase (tTG) based test and Deamidated gliadin peptide (DGP) test. The road to recovery for these patients lies with the consumption of Gluten Free Diet (GFD) and this ensures that the intestinal mucosa returns to normalcy and accordingly decreases the incidence of Hypoglycemia. A gluten-free diet (GFD) should be introduced only after the completion of the diagnostic process, when a conclusive diagnosis has been made.

Combined use of serology and biopsy is advocated for Celiac Disease diagnosis in view of limitations of serology and biopsy individually. Biopsy of the intestine stands out to be the gold standard for testing of Celiac Disease but it is only limited to late diagnosis and hence for early detection the serological kits take predominance. J. Mitra & Co. Pvt. Ltd. envisages in providing the most affordable and easy to use ELISA kits for Celiac diagnosis.While both RDT or ELISA hold advantage over Anti-endomysial test (EMA) as they are not labor intensive and doesn’t require any waiting period for the patients. To add to the benefit of the Lab and the patient the ELISA test provided by J. Mitra & Co. Pvt. Ltd. also has the option of reporting in both Semi Quantitative and Quantitative modes.

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