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  • Jefferson Adams
    Jefferson Adams

    Do Teens with Celiac Disease Have More Eating Disorders?

      We know that teens with celiac disease face challenges following a gluten-free diet. A recent study shows that teens with celiac disease may be at higher risk of developing eating disorders.

    Caption: Goldilocks - Eating Disorders. Image: CC--Daniela Brown

    Celiac.com 02/27/2019 - To avoid the chronic inflammation, discomfort and damage associated with celiac disease, celiac patients need to follow a strict, lifelong gluten-free diet. That can be a challenge for teens and young adults, as shown by a number of earlier studies. Some studies have indicated that the challenge of following a gluten-free diet can cause stress and raise the risk for disordered eating behavior in some people.

    Teens and young adults with disordered eating behaviors face a greater risk of developing full-blown eating disorders. To better understand the issues involved, a team of researchers recently set out to assess the incidence and risk factors for disordered eating behaviors among individuals with celiac disease, and to examine a connection between a gluten-free diet and disordered eating behaviors.

    The Israeli research team included Itay Tokatly Latzer, Liat Lerner-Geva, Daniel Stein, Batia Weiss, and Orit Pinhas-Hamiel. For their Level V, cross-sectional descriptive study, the team submitted a personal and dietary survey that included questions on gender, age, weight, disease duration, along with two self-rating questionnaires that assessed disordered eating behaviors and adherence to a gluten-free diet: the Eating Attitudes Test-26 and the gluten-free diet questionnaire.

    They collected a total of 136 responses from celiac disease patients. They found in 7% of male and nearly 20% of female subjects. In general, patients who experienced disordered eating were overweight, older, and female. 

    About one in three patients reported strict adherence to a gluten-free diet, independent of age, disease duration, age at diagnosis of celiac disease, or being overweight.

    According to this data, a significant number of adolescents with celiac disease experience disordered eating patterns, especially those who are overweight, older and female. Extra attention to this issue might help to disrupt these patterns and to prevent them from becoming worse in the future. 

    Read more at Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity



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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    Celiac.com 12/23/2013 - Symptoms of celiac disease negatively impact the social activities and emotional states of some patients. A team of researchers recently set out to assess rates of altered eating behavior in celiac patients.
    The research team included V. Passananti, M. Siniscalchi, F. Zingone, C. Bucci, R. Tortora, P. Iovino, and C. Ciacci. They are variously affiliated with the Department of Clinical and Experimental Medicine at University Federico II of Naples, Italy, and with the Department of Medicine and Surgery, University of Salerno, Baronissi Campus, in Salerno, Italy.
    The researchers evaluated 100 celiac adults and 100 control subjects of statistically similar gender, age, and physical activity. The researchers had both celiac patients and control subjects complete a dietary interview and the Binge Eating Staircases, Eating Disorder Inventory (EDI-2), Eating Attitudes Test, Zung Self-Rating Depression Scale, State Trait Anxiety Inventory Forma Y (STAI-Y1 and STAI-Y2), and Symptom Check List (SCL-90).
    The results showed that, compared with the control group, celiac patients had higher STAI-Y1 and STAI-Y2, Somatization, Interpersonal, Sensitivity, and Anxiety scores of the SLC-90.
    EDI-2 differed in pulse thinness, social insecurity, perfectionism, inadequacy, aceticisms, and interpersonal diffidences between celiac disease patients and healthy female controls, whilst only in interceptive awareness between celiac disease patients and healthy male controls.
    Celiac patients with gastrointestinal symptoms showed dependently higher EAT-26 scores. The EAT26 showed a connection between indices of diet-related disorders in both celiac disease, and the feminine gender after controlling for anxiety and depression.
    Eating disorders appear to be more frequent in young celiac women than in celiac men and in healthy control subjects.
    Overall, these results indicate that pathological eating behavior in celiac adults may be due to celiac disease itself, rather than the gastrointestinal related symptoms or psychological factors.

    Source:
    Gastroenterology Research and Practice Volume 2013 (2013), Article ID 491657

    Jefferson Adams
    Celiac.com 04/06/2017 - A new study showing connections between anorexia nervosa and celiac disease, both before and after celiac diagnosis, is raising eyebrows and inviting questions. Results of the study appear in the April 3 issue of Pediatrics.
    Because the two conditions share a number of symptoms, including abdominal pain, bloating, diarrhea, and underweight, doctors can have some difficulty telling them apart.
    Until now, previous data linking anorexia with celiac disease came mostly from individual case reports. To get a better picture, Karl Mårild, MD, PhD, from the Barbara Davis Center, University of Colorado, Aurora, and colleagues conducted a cohort and case-control investigation examining the connection between celiac disease and timing of diagnosis for anorexia nervosa.
    To do this, the research team reviewed records from Sweden's 28 pathology departments. They looked at 17,959 cases of small intestinal biopsy-verified celiac disease in women from 1969 through 2008, and compared them with 89,379 sex- and age-matched population-based controls. The team confirmed cases of anorexia nervosa through inpatient and hospital-based outpatient records.
    They also looked at individuals undergoing biopsy who showed small intestinal inflammation or normal mucosa, but tested positive for celiac-related autoantibodies. They recorded educational level, socioeconomic status, and type 1 diabetes status.
    Their results showed that the hazard ratio for developing anorexia nervosa after a celiac diagnosis was 1.46, which fell to 1.31 beyond the first year after celiac diagnosis (with a 95% confidence interval for both). The odds ratio for association of previous anorexia nervosa diagnosis among people with a diagnosis of celiac disease was 2.18, with a 95% CI.
    The findings remain the same, even after the team adjusted for type 1 diabetes status and socioeconomic levels. Women who had positive celiac serology, but with no signs of villous atrophy, were also more likely to be diagnosed with anorexia nervosa, both before and after celiac diagnosis.
    The researchers propose three explanations for these findings: First, celiac disease may have been misdiagnosed earlier as anorexia nervosa, or vice versa. Second, it's possible that closer scrutiny of patients diagnosed with one condition may have prompted a bias in detecting the second condition. Third, it's possible that people with a shared genetic susceptibility may face a higher risk of developing both conditions.
    Whatever the reason behind the association, the study indicates that the connections between the two conditions are likely complex, and definitely invites further study.
    In the meantime, the researchers write that the "bidirectional association between diagnosis of anorexia nervosa and celiac disease warrants attention in both the initial assessment, and in the follow-up of women with these illnesses."
    As a result of this study, the team encourages "physicians to closely monitor these patients and calls for heightened understanding of factors that contribute to their co-occurrence."
    Source:
    Pediatrics. Published online April 3, 2017

    Jefferson Adams
    Celiac.com 02/19/2018 - It's very important that people with celiac disease maintain a gluten-free diet. Still, there has been some data to suggest that some people with celiac disease may be "hyper vigilant" in their approach to a gluten-free diet, and that such extreme vigilance can cause them stress and reduce their overall quality of life. Can a more relaxed approach improve quality of life for some people with the disease?
    A team of researchers recently set out to determine whether "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). The research team included Randi L. Wolf, Benjamin Lebwohl, Anne R. Lee, Patricia Zybert, Norelle R. Reilly, Jennifer Cadenhead, Chelsea Amengual, and Peter H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College Columbia University New York USA, the Department of Medicine, Celiac Disease Center Columbia University Medical Center, Harkness Pavilion New York, USA.
    The team assessed the influence of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet. For their cross-sectional prospective study, the team looked at 80 teenagers and adults, all with biopsy-confirmed celiac disease, living in a major metropolitan area. They assessed QOL using celiac disease-specific metrics. The team based dietary vigilance on 24-hour recalls and an interview. They based knowledge on a food label quiz. They used open-ended questions to describe facilitators and barriers to following a gluten-free diet.
    Overall, extremely vigilant adults had greater knowledge, but significantly lower QOL scores than their more relaxed counterparts. Both teens and adults who reported lower energy levels had much lower overall QOL scores than those with higher energy levels.
    To maintain a strict gluten-free diet, hyper-vigilant celiacs were more likely to avoid eating out, to cook at home, and to use internet sites and apps. For hyper vigilant eaters, eating out was especially challenging. Being hyper-vigilant about maintaining a strict gluten-free diet can cause stress and adverse effects in both teens and adults with celiac disease.
    Doctors may want to look toward balancing advocacy of a gluten-free diet with promoting social and emotional well-being for celiac patients. In some cases, allowing a more relaxed approach may increase well-being and, thus, make dietary adherence easier. Obviously, people would need to tailor any relaxation in their gluten-free vigilance to make sure they weren't suffering preventable symptoms or doing themselves any harm.
    Source:
    Dig Dis Sci (2018)

    Jefferson Adams
    Celiac.com 03/28/2018 - Compliance with a gluten-free diet is difficult at all ages, but particularly for teenagers due to social, cultural, economic, and practical pressures. 
    A team of researchers recently set out to assess the rates and determining factors of non-adherence to a gluten-free diet, along with the nutritional status of children and adolescents with celiac disease in a tertiary Brazilian referral center.
    The research team included Maraci Rodrigues, Glauce Hiromi Yonaminez, and Carla Aline Satiro. They are variously affiliated with the Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of Sao Paulo (SMUSP), Av. Dr Eneas de Carvalho Aguiar, 255, 05403-000, Sao Paulo, Brazil, and the Department of Pediatric, Instituto da Criança, Division of Nutrition, Hospital das Clínicas, School of Medicine, University of Sao Paulo in Sao Paulo, Brazil.
    The team’s cross-sectional and retrospective study included patients under 20 years of age, with biopsy-confirmed celiac disease, followed regularly at the Department of Pediatrics, Division of Gastroenterology, Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil, were surveyed using a questionnaire and serologic test applied between November 2011 and February 2012. 
    The team reviewed patient charts to collect the anthropometric data along with the results of the serologic test performed both at the time of diagnosis, and after at least 1 year of a gluten-free diet. They assessed 35 patients aged between 2.4 and 19.9 years. Average patient age at diagnosis was 5.4 years. Nearly 70% of the patients were women, nearly 90% had classical celiac disease, while just over 50% had other celiac-associated conditions. Despite dietary guidance, one in five patients reported deviating from the gluten-free diet. 
    After five years of gluten-free diet, most children achieved normal height and weight, while some of the children gained an excessive amount of weight, especially in the first two years of gluten-free eating.  Most deviation from gluten-free eating was intentional, and occurred at parties and other social gatherings.
    In addition to teaching self-management skills, factors that promote knowledge and tools to manage celiac disease among independent children and adolescents include more choices and easier access of low cost gluten-free foods, and increased family discussions about the benefits of eating gluten-free diet. 
    Helping kids and adolescents with celiac disease to effectively manage their condition by closely following a gluten-free diet is crucial, and parents have an important role to play in reinforcing information from doctors and health care professionals.
    Source:
    BMC Gastroenterol. 2018; 18: 15. doi: 10.1186/s12876-018-0740-z

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