According to the recent National Family Health Survey in India, about 7.7 percent of children in India suffer from severe acute malnutrition. That translates into about 87 lakh children under five who are frail, underweight, and at high risk of dying from infections because of their weakened immune system.
Doctors treating these children started noticing that some children were not getting better even after being fed properly. Their bodies did not seem to absorb food.
What was happening? What was stopping the absorption of nutrients?
Paediatricians started suspecting celiac disease, a condition where a person’s immune system reacts to gluten, a protein in wheat, barley and rye. In celiac disease, the immune system reacts to gluten byproducts. The immune reaction changes the lining of the small intestine, flattening the tiny finger-like structures, villi, that normally absorb nutrients from food. Over time, this makes it very hard for the body to absorb nutrients. So children hospitalised with severe malnutrition may actually have undiagnosed celiac disease.
What percentage of malnourished children have celiac disease? How can we distinguish them?
A team of researchers at the Institute of Medical Sciences, BHU, Banaras, studied around one hundred and forty children, aged between six months and five years, diagnosed with malnutrition. Twenty children were excluded because they also had heart disease or kidney problems – confounding variables.
The doctors started testing these children for celiac disease. They did a blood test to look for a specific antibody, tissue transglutaminase 2 immunoglobulin A, that the body produces when it reacts to gluten. A high level of the antibody suggests that the person has celiac disease.
They also did a gut biopsy. They took a tiny sample of tissue from the small intestine and examined it under a microscope to see if the villi were damaged. Children were diagnosed with celiac disease only if the blood test came back positive and the biopsy confirmed damage to the gut lining.
Out of the one hundred and forty children, forty children, nearly 3 in every 10 children, had undiagnosed celiac disease. These children had never been tested before and their celiac disease had been making their malnutrition worse.
Celiac disease is hereditary. It is linked to the genes coding a class II human leukocyte antigen type. People who carry some variants of these genes are more likely to develop celiac disease. So a genetic test was also done to see if the child carries genes linked to celiac disease.
The genetic test results were also surprising. Among the children with celiac disease almost ninety-five percent were carrying the celiac-linked gene variants, compared to almost sixty percent of the malnourished children without celiac disease.
In the general population, only around 4 in 10 people carry these gene variants. So often, even malnourished children carry these genes. They might be at risk of developing celiac disease later, even if they don’t show the symptoms yet.
One particular gene, HLA-DQ2.5, stood out as the strongest single risk factor. Children carrying it were nearly four times more likely to have celiac disease than those without it. This same gene was also linked to the highest antibody levels and the worst intestinal damage.
Blood test for immunoglobulin A alone was not the accurate or reliable diagnosis. When negative, it correctly ruled out celiac disease in almost ninety-five percent of the cases. But it was not good at confirming the diagnosis because young and malnourished children produce fewer antibodies than expected even when celiac disease is present. Biopsy is also done to confirm the diagnosis.
The doctors argue that hospitals treating severely malnourished children should routinely test for celiac disease. If the diagnosis is confirmed, removing gluten from the diet, allows the gut to heal and finally start absorbing nutrients properly.
This research suggests that celiac disease is a common, and treatable contributor to severe malnutrition in children. A child who isn’t improving despite being fed well may actually be fighting an unrelated immune reaction to gluten. Invisible unless specifically tested. Testing for the gene variant, HLA-DQ2.5 can help parents take adequate precautions to avoid malnutrition in children with a propensity for celiac disease.
The percentage of children with malnutrition due to gluten allergy vary based on the mutations of the transglutaminase 2 gene. In some regions of India, such mutations are more common. Therefore, a large scale database of such mutations in Indian populations can help public health authorities to take informed decisions on tackling malnutrition in children as well as adults.
Indian Pediatrics 63 (8): 552 (2026);
10.1007/s13312-026-00297-5
Reported by Anuska Karmakar
PhD scholar, JNU
This report was written in a workshop organised by scienceandmediaworkshops.
The reports on this site is free-to-use for Indian media houses.
Leave a comment