Les particularités de la maladie cœliaque chez l’enfant 1713

Dr Moussayer khadija, 1 y.

- Science - Society - Health -

3.3 min read.

La maladie cœliaque ou intolérance au gluten est une pathologie auto-immune chronique, qui touche les intestins, suite à l'ingestion de gluten. Il s'agit plus précisément d'une intolérance (et non d'une allergie) à un composant du gluten, la gliadine (ensemble de protéines constituant les farines de certaines céréales, dont le blé, le seigle, l'orge, l'avoine). Le diagnostic de ce trouble est souvent difficile et tardif. Il n'existe toujours pas de traitement curatif et sa seule résolution réside dans l'exclusion de tout gluten de l'alimentation générale. Chez les très jeunes enfants (moins de 3 ans), il y a plus souvent présence de diarrhée, de distension abdominale et de retard de croissance. Les enfants plus âgés et les adolescents seraient plus sujets à présenter d’autres symptômes gastro-intestinaux (douleurs abdominales récurrentes, constipation ou vomissements) ou des symptômes extra-intestinaux. LES SYPTOMES DE LA MALADIE COELIAQUE CHEZ L’ENFANT Elle se manifeste essentiellement de deux manières chez les enfants : - la maladie cœliaque avec des manifestations gastro-intestinales impliquant une croissance médiocre, un abdomen distendu, des diarrhées, des vomissements, des troubles de la croissance avec une cassure de la courbe staturo-pondérale. - la maladie cœliaque atypique avec des manifestations peu significatives, des troubles à des organes autres que l’intestin, une croissance médiocre et assez souvent une anémie en fer ou en acide folique . L’enfant peut aussi présenter des manifestations auto-immunes ou être diagnostiqué de ce type de pathologie. Sachant qu'elles peuvent être associées à la maladie cœliaque, il convient alors de faire des examens en procédant à une recherche d'anticorps, notamment chez les enfants atteints de diabète de type1, de thyroïdite ou d'alopécie areata. Cette recherche est nécessaire aussi pour les enfants atteints de maladies rares comme le syndrome de Down ou de Turner. LES TESTS SANGUINS DE DETECTION DE LA PATHOLOGIE Le diagnostic de la maladie cœliaque doit être réalisé avec rigueur selon des protocoles internationaux au moyen de tests sanguins spécifiques et éventuellement par gastroscopie avec prélèvements biopsiques si nécessaire. Le dosage des anticorps anti-transglutaminase spécifiques de la maladie cœliaque, lorsqu'il est détecté avec une valeur élevée, est le test sanguin le plus approprié à réaliser pour le diagnostic suspecté de la maladie cœliaque. Il doit être associé à la détermination des immunoglobulines IGA totales. UNE PREDISPOSITION GENETIQUE La maladie cœliaque est une maladie à forte prédisposition génétique. Elle est en relation avec notre carte d’identité biologique : le système HLA (Human leukocyte Antigen), un ensemble de molécules situées à la surface des cellules pour permettre au système immunitaire de les reconnaitre. La présence de gènes spécifiques HLA DQ2 et DQ8 chez presque tous les cœliaques est un élément nécessaire mais non suffisant pour développer la maladie, puisque qu’on les retrouve aussi en moyenne dans 35% de la population alors que la maladie n’en touche que 1%. LE TRAITEMENT : LE REGIME SANS GLUTEN Le régime sans gluten (RSG) ne doit être mis en place qu'après confirmation du diagnostic, car l'élimination du gluten de l'alimentation de l'enfant entraîne des tests négatifs et la résolution des symptômes, compromettant un diagnostic ultérieur de certitude. Pour le moment, le seul traitement consiste à suivre ce régime alimentaire sans gluten (RSG). Le gluten et les protéines apparentées sont présents dans la majorité des céréales (blé, orge et seigle). Le gluten est présent aussi dans de nombreux produits très divers et souvent insoupçonnés : médicaments, rouge à lèvres, rince-bouche, dentifrice, colle, bonbons, sauce à salade, plats cuisinés… Le patient doit alors se diriger vers des produits de substitution sans gluten comme le riz (blanc, semi-complet, complet), des légumineuses (lentilles, pois chiches, haricots rouges…) ainsi que des céréales non toxiques et pseudo-céréales anciennes ou venues d’autres continents (sarrasin, millet, quinoa ou encore amarante originaire d’Amérique du sud). Au Maroc, la bonne observance du régime sans gluten est compliquée du fait qu’il n’existe pas d’étiquetage obligatoire sur ce sujet L’ASSOCIATION MAROCAINE DES INTOLERANTS ET ALLERGIQUES AU GLUTEN (AMIAG) Fondée en 2013, l’AMIAG a su s’imposer rapidement comme l’association nationale de référence pour la maladie cœliaque au Maroc et est reconnue comme telle par ses partenaires à l’étranger. Elle est présidée par Mme Jamila Cherif Idrissi. Comptant près de 1 000 adhérents, elle a mis en place ou organise : la journée nationale de la maladie cœliaque chaque année en mai ; des ateliers culinaires ; une grande fête annuelle pour les enfants cœliaques ; des conférences scientifiques avec des experts nationaux et internationaux, en particulier lors d’événements des professionnels de santé ; des aides alimentaires et des dons de moulins à céréales aux familles les plus pauvres… . Dr Moussayer khadija, spécialiste en médecine interne et en Gériatrie, vice - présidente de l’association marocaine des intolérants et allergiques au gluten (AMIAG) BIBLIOGRAPHIE - L’effiler D. Celiac disease diagnosis and management. JAMA. 2011;306(14):1582–92 - Ford AC and al. Yield of diagnostic tests for celiac disease in individuals with symp-toms suggestive of irritable bowel syndrome. Arch Intern Med. 2009;169(7):651–8. - Husby S. and al Guidelines for the Diagnosis of Coeliac Disease., for the ESPGHAN Working Group on Coeliac Disease Diagnosis, on behalf of the ESPGHAN Gastroenterology Committee European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN 2012; 54: 136–160. -Diagnostic de la maladie cœliaque chez l'enfant Diagnosis of celiac disease in children, Elsevier Perfectionnement en Pédiatrie Volume 5, Issue 2, Supplement 1, May 2022, Pages S2-S6 https://doi.org/10.1016/S2588-932X(22)00071- OVERVIEW Celiac disease, defined as permanent intolerance to gluten, is an autoimmune disease, where the immune system attacks, in genetically predisposed individuals, the intestinal villi. The resultant atrophy of the intestinal wall causes malnourishment of nutrients and many other complications. The auto-immune diseases are a broad range of related diseases in which a person’s immune system produces an inappropriate response against its own cells, tissues and/or organs, resulting in inflammation and damage. There are over 100 different autoimmune diseases, and these range from common to very rare diseases. Some of the over 100 autoimmune diseases are lupus, type 1 diabetes, scleroderma, multiple sclerosis, Crohn’s disease, autoimmune hepatitis, rheumatoid arthritis, Graves disease, myasthenia gravis, myositis, antiphospholipid syndrome (APS), Sjogren’s syndrome, uveitis, polymyositis, Raynaud’s phenomenon, and demyelinating neuropathies

Dr Moussayer khadija

Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM)

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Multidimensional Poverty: Decoding the Oxford Index and the Situation in Morocco 139

Aziz Daouda, 17 h.

- Politics - Society -

3 min read.

When poverty is mentioned, it is often thought of as insufficient income. However, poverty encompasses much broader and more complex dimensions such as access to education, health, decent housing, and other basic resources depending on societies and their cultures. It is on this or a very similar basis that the Multidimensional Poverty Index (MPI) was designed and unveiled in 2010 by the Oxford Poverty and Human Development Initiative (OPHI) at the University of Oxford. The index was adopted during the 20th anniversary of the United Nations Development Programme (UNDP). But what exactly is multidimensional poverty or the Oxford Index? *Multidimensional poverty is the simultaneous and synchronous deprivation experienced by individuals across different essential aspects of life. The Oxford Index, or MPI, aims to measure this aspect of poverty based on 10 indicators grouped into three main dimensions: health, in terms of nutrition and child mortality; education, concerning school attendance, years of schooling, and living conditions; namely access to drinking water, electricity, sanitation facilities, quality housing, and essential assets.* A household is considered poor according to the MPI if its members are deprived in at least 33% of these indicators. The index is calculated using a simple formula: **MPI = H × A** where **H** is the proportion of people who are poor and **A** is the average intensity of deprivation among these people. This approach provides a more nuanced diagnosis than a simple monetary measure of poverty. It allows identifying the exact origin and nature of the deprivations and thus more effectively guides public action. The introduction of the MPI in Morocco has profoundly renewed the understanding of poverty in the country. Ten years ago, this index stood at 11.9%. Thanks to significant mobilization and targeted policies, this rate has decreased to 6.8% according to the 2024 national census, representing a halving. Translated into numbers of affected people, the rate dropped from 4.5% to 2.5% of Morocco’s current 36 million population. Despite these notable advances, poverty remains marked by strong regional and social disparities. Deprivations mainly concern education and living conditions such as access to drinking water, decent housing, and medical care. Multidimensional poverty is more concentrated in rural areas, accounting for 72% of the poor, with an alarming rate among rural children estimated at nearly 69%. In his 26th Throne Speech, His Majesty the King acknowledged the progress made while expressing dissatisfaction and the determination to rapidly correct the situation. Indeed, Morocco is still behind many other countries that display lower multidimensional poverty rates and have recorded faster declines in the index; some countries have therefore succeeded better. For example, Croatia already had a rate below 0.5% in 2022. China, with 12.5% in 2002, and Turkey, with an index of 8.5% in 2007, have recorded faster decreases and are now among the best-ranked countries. Several countries in Asia and Latin America have also seen significant declines thanks to innovative strategies, ambitious social policies, and sustained international support. Morocco remains better ranked compared to many Sub-Saharan African countries. Mali had an MPI of 77.7% in 2012 and Burundi 80.8% in 2010. However, Morocco still maintains a significant gap with global leaders and even some developing countries in the Mediterranean and Asia. To enable the Kingdom to maintain and accelerate its progress, drastic and effective measures requiring genuine political courage and boldness are needed. Several avenues should be considered simultaneously, such as: - Optimizing investment in education by reducing school dropout, promoting equal access for girls and boys in rural areas, and improving teaching quality and attractiveness through teacher qualification and adapted curricula. - Seriously addressing the issue of the language of instruction. Moroccans speak a language that is not reflected in schools. Darija is the Moroccan language and should be valorized to create a continuum between everyday life and learning. All education specialists and dedicated international bodies insist on the use of the mother tongue for more efficient learning, at least in the early school years, as seen in all countries successful in education. - Redefining what illiteracy means in Morocco. Is it still appropriate to consider illiteracy as the inability to master languages that are not used in daily life? The working language and trades that sustain Moroccans and in which all exchange, communicate, and act are not taken into account. This question must be reconsidered in light of scientific evidence, without outdated or unproductive dogma or ideology. - Accelerating medical coverage and social protection through a faster and less restrictive generalization. - Encouraging health and education professionals to settle in remote and targeted areas through significant financial incentives and housing. - Expanding and strengthening basic infrastructure with particular focus on drinking water, electricity, sanitation, and social housing even in rural areas. The issue posed by scattered housing should no longer be a taboo. Some recurring problems simply cannot be solved in certain regions due to the type and location of housing. - Targeting public efforts territorially through fine planning and priority allocation of appropriate resources to the most vulnerable regions, taking into account the real needs of the populations concerned. - Developing and refining social safety nets and resilience mechanisms to better protect populations affected by climate change. By adopting an integrated, territorially targeted approach based on precise MPI data, Morocco can consolidate the gains already made and catch up with the best performers in the region and the world in the near future, given its stability, significant growth rate, diversified and increasingly efficient economy, and, of course, the ingenuity of its people.

[Science #4] Precision Nutrition: Tailoring Your Diet Beyond Hunger and Excess 360

Fatima Zahra EL hajji (Tima EL), 4 d.

- Science - Health -

1.7 min read.

- Science Series -

Hunger and dietary excess may seem like opposite ends of the spectrum, yet both can undermine health. Too few calories disrupt essential physiological processes and energy metabolism, while chronic overeating—especially of nutrient-poor foods—can drive metabolic dysfunction, chronic inflammation, and raise the risk of long-term diseases. Ironically, consuming more nutrients than needed often fails to meet the body’s precise biochemical demands, accelerating cellular wear and potentially shortening lifespan. Emerging research suggests that certain calorie-dense foods, when consumed carelessly, may harm healthspan—the number of healthy years lived. Conversely, mindful nutrient intake—or even periods of moderate hunger—can sometimes benefit overall physiology more than habitual overeating. The key lies in recognizing that each individual’s nutritional needs are unique. This is the foundation of Precision Nutrition. **From "One-Size-Fits-All" to Tailored Nutrition** The term “precision” is often associated with medicine, where a treatment is matched to a patient’s genetic profile instead of relying on a standard prescription. That same philosophy is now transforming the way we think about food. Personalized nutrition moves beyond outdated dietary guidelines by using your genetic makeup, lifestyle, and preferences to determine which foods serve your body best. Your DNA might reveal, for example, that you absorb certain vitamins inefficiently, or that specific foods help stabilize your blood sugar more effectively. This approach empowers you to make dietary choices tailored to your biology—not to fleeting trends. **How Does It Work?** It starts with a DNA sample, analyzed for hundreds of tiny genetic variations known as polymorphisms. These influence traits like lactose intolerance, vitamin D absorption, caffeine metabolism, and sensitivity to salt or sugar. Using advanced algorithms, nutrition scientists translate this data into actionable diet strategies. For instance: - If your genes show low omega-3 absorption, your plan might emphasize fatty fish, flaxseed, or targeted supplements. - If you metabolize caffeine slowly, reducing coffee intake could help avoid sleep problems or anxiety. One striking example comes from the GC gene, which affects how well your body raises blood vitamin D levels after supplementation. People with certain GC variants may require more sunlight exposure or higher supplement doses to achieve optimal health. The power of personalized nutrition lies in decoding the relationship between your genes and every bite you take—turning food into a truly personal form of medicine. A comprehensive understanding of each individual’s unique nutritional needs—driven by genetic, metabolic, microbiome, and lifestyle factors—enables the development of personalized dietary interventions that have transformative potential far beyond individual health. Precision nutrition not only enhances quality of life and healthspan but also offers a pathway to optimize resource use and address global challenges such as hunger and malnutrition. Emerging perspectives highlight that precision nutrition, while often associated with high-income countries, is increasingly seen as a vital strategy to democratize health and tailor nutrition recommendations for entire populations, including those in low- and middle-income countries where malnutrition and food insecurity remain urgent issues. By leveraging advanced technologies and data-driven diagnostics, precision nutrition can target specific micronutrient deficiencies, metabolic conditions, and even genetic variations prevalent in different communities. This targeted approach moves beyond generic dietary guidelines, allowing for more effective, culturally relevant, and sustainable interventions that better meet the biochemical and physiological demands of diverse populations.