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Celiac.com 06/27/2022 - Consumer gluten-free diet and sales of gluten-free products have increased immensely over the last decade, fueled in part by allergies and sensitivities in some, and by the popular perception that the diet is healthier by many others. The popularity of the gluten-free diet has led a group of researchers to explore the physical and mental effects that gluten might have on young people, especially in those with existing stomach and gut issues. The research team set out to assess the effects of gluten in adolescents and young adults with existing gastrointestinal symptoms and enrolled nearly 275 eligible adolescents, with at least four different gastrointestinal symptoms, from a population-based cohort of nearly thirteen-hundred. In phase one of the study, fifty-four participants lived gluten-free for 2 weeks. Thirty-three participants who improved during phase one then moved to phase two. Phase two was a blinded randomized cross-over trial, in which participants were blindly randomized either to start with 7 days of gluten, eating two granola bars containing 10g of gluten or to 7 days on placebo, eating two granola bars without gluten, followed by the reverse and separated by a 7-day washout period. The team measured any effects of the intervention on gastrointestinal symptoms and participant mental health. Overall, just under sixty of the 273 participants entered the run-in phase, with 35 eligible for randomization. A total of 33 were randomized, while 32 completed the trial. Average age was just over 20 years old, and nearly all participants were women. The team found that, compared with placebo, adding gluten to the diet did not trigger gastrointestinal symptoms or negatively affect mental health in adolescents who participated in this trial. Read more in Alimentary Pharmacology & Therapeutics 29 March 2022 The research team included Caecilie Crawley, Nadia Savino, Cecilie Halby, Stine Dydensborg Sander, Anne-Marie Nybo Andersen, Manimozhiyan Arumugam, Joseph Murray, Robin Christensen, and Steffen Husby. They are variously affiliated with the Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark; the Department of Clinical Research, University of Southern Denmark, Odense, Denmark; the Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; the Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; the Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; the Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; the Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.

Celiac.com 11/15/2021 - For people with celiac disease, managing a strict gluten-free diet can be challenging, even in the best of circumstances. The process can be confusing, frustrating, embarrassing and depressing. For many, especially young people, trying to navigate and manage a gluten-free diet can lead to impaired psychosocial well-being, a diminished quality of life and disordered eating. We know, for example, that children and adolescents with celiac disease, and non-celiac gluten sensitivity, face extra challenges with academic or emotional well-being, and may be at higher risk for disordered eating. Adolescents can also suffer stress when trying to manage a gluten-free diet. A team of researchers recently set out to understand adolescents’ approaches to managing a gluten-free diet and the association with quality of life. Here's what they found. Using the Celiac Dietary Adherence Test and quality of life survey, researchers tested and surveyed a group of thirty adolescents with celiac disease, who ranged from 13–17 years old, and had been following a gluten-free diet for at least 1 year. To explore the teens' approaches to gluten-free diet management, the researchers used a semi-structured interview that focused on developing key themes using an iterative process, and classified their management strategies and quality of life using psychosocial rubric. They then compared Celiac Dietary Adherence Test ratings across groups. Using a four point scale, the team classified the gluten-free diet strategies that drive adaptive eating behaviors. They characterized behaviors by: greater flexibility (as opposed to rigidity); trust (as opposed to avoidance); confidence (as opposed to controlling behavior) and awareness (as opposed to preoccupation). More than half of those surveyed reported using maladaptive approaches to manage their gluten-free diet. Patients using maladaptive approaches to manage their gluten-free diets were more likely to be older, with lower celiac-specific Pediatric Quality of Life scores. Scoring differences between the groups ranged from 15.0 points for Isolation to 23.4 points for Limitations. Adolescents with celiac disease, who manage a gluten-free diet using maladaptive eating behaviors that are similar to feeding and eating disorders, report lower quality of life. Teens with lower QOL scores in areas like school or emotional function might require interventions, including a Section 504 plan or meeting with a psychologist or social worker. To reduce this risk, the team recommends that adolescents with celiac disease receive regular follow-up visits with gastroenterologists and dietitians, along with psychosocial support, as needed. Parents of adolescents with celiac disease should also talk with, and listen to their celiac teens about the dietary pressures and difficulties facing them on a daily basis. Making sure that adolescents with celiac disease learn to use healthy strategies to properly manage their gluten-free diet will help to ensure that future generations of celiac sufferers have a smoother path and a better quality of life. Remember, when our teens thrive, we all win! Read more in the Journal of Human Nutrition and Dietetics The research team included J. W. Cadenhead, R. L. Wolf, B. Lebwohl, A. R. Lee, P. Zybert, N. R. Reilly, J. Schebendach, R. Satherley, and P. H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University in New York, NY; the Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA; the Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; and the Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, King's College London in London, UK.

Celiac.com 03/29/2021 - A team of researchers recently set out to analyze the connection between celiac disease and depression in children, adolescents, and young adults with Type 1 diabetes. For their study, the team looked at nearly 80,000 patients aged 6–20 years, with Type 1 diabetes lasting at least six months, and treatment data, in the diabetes patient follow-up registry, between 1995 and 2019. The team assigned the patients to one of four groups: Type 1 diabetes patients, numbering 73,699; Type 1 diabetes + celiac disease, numbering 3,379; Type 1 diabetes + depression, numbering 1877; or Type 1 diabetes + celiac disease + depression, numbering 112 patients. The results showed a strong association between celiac disease and depression. Depression and celiac disease were more frequent in women, compared with Type 1 diabetes. Patients with Type 1 diabetes + celiac disease, and Type 1 diabetes + depression, were more likely to use insulin pumps compared with Type 1 diabetes only. HbA1c was higher in Type 1 diabetes + depression, Type 1 diabetes + celiac disease + depression, both compared with Type 1 diabetes only. Compared with Type 1 diabetes patients, patients with Type 1 diabetes + celiac disease + depression were more likely to have comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders. The results support a strong connection between celiac disease and depression in young people with Type 1 diabetes. The team hypothesizes that the emotional weight of Type 1 diabetes and celiac disease together may increase a patient's risk for depression. Depression was also associated with additional psychological and neurological comorbidities. In addition to screening Type 1 diabetes patients for celiac disease at regular intervals, the team suggests celiac disease patients might screening benefit from regular depression screening. Read more in Acta Diabetologica (2021) The research team included Sascha René Tittel, Désirée Dunstheimer, Dörte Hilgard, Burkhild Knauth, Elke Fröhlich-Reiterer, Angela Galler, Michael Wurm, and Reinhard Walter Holl. They are variously affiliated with the Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany; the German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; the Paediatrics and Adolescent Medicine, Medical Faculty University of Augsburg, Augsburg, Germany; the Department of Pediatrics, Witten, Germany; the Department of Pediatrics and Adolescent Medicine, CJD Berchtesgaden, Berchtesgaden, Germany; the Division of General Pediatrics, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria; the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; the Clinic St. Hedwig, University Children’s Hospital Regensburg (KUNO Clinics), University of Regensburg, Regensburg, Germany; the Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany; and the German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.

Celiac.com 06/23/2016 - Digestive Disease Week 2016 took place in San Diego from May 21-24. Among the presentations given was one that stood out for its obvious health impacts. That presentation was given by Jonathan Cordova, DO, pediatric gastroenterologist at the University of Chicago Medical Center. His presentation tied celiac disease to major depressive disorder in adolescents, and stated that most adolescents with celiac disease have symptoms consistent with the disorder. Dr. Cordova said that "...interim analysis does suggest that a majority of adolescents living with celiac disease may have symptoms consistent with major depressive disorder," and that the depression has a negative impact on their quality of life, "but does not appear to be associated with their celiac disease state." That is, the depression does not seem to be impacted by how well their celiac disease is doing. Healthy gut and gluten-free diet, or unhealthy gut, with symptoms, it doesn't seem to matter. The depression levels seem about the same whatever the case. A number of recent studies indicate that depression and anxiety are the main reasons people with celiac disease report decreased quality of life, Dr. Cordova and his colleagues wrote. But, most of these studies were done on adults, almost none used adolescents, and adolescents may be more susceptible to depression. The research team was able to connect celiac disease with mental health disorders in adolescents by administering questionnaires to adolescents and their parents. Average age of adolescents was 14.6 years at the time of survey and 11.2 years at the time of diagnosis. The researchers found no correlation between celiac disease and depression, anxiety, ADHD, age at survey, quality of life, age at diagnosis or length of time on a gluten free diet. However, the majority of adolescents and parental reports screened positive for major depressive disorder. Interestingly, a parent's perception of the state of their child's celiac disease impacted their perception of depression in their child. Dr. Cordova says that "the data suggests that early screening for depression in any adolescent with celiac disease is crucial to help optimize behavioral health," Dr. Cordova's team plans to follow these patients into young adulthood, and aims to re-screen them again in 5 years. Reference: Cordova J, et al. Abstract #844. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego

Celiac.com 02/03/2020 - Celiac disease is a common autoimmune condition that can have negative physical and psycho-social consequences in kids with the disease. A team of researchers recently set out to document health-related quality of life (HRQOL) in a large group of children with newly diagnosed celiac disease using the PedsQL 4.0 Generic Core Scales. They wanted to compare it against data for healthy children and children with non-celiac gastrointestinal (GI) problems using established data. The research team included Mary Shull; Tracy Ediger; Ivor Hill; and Rose Schroedl. They are variously affiliated with the Department of Gastroenterology, Hepatology, and Nutrition; the Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH; and the Gastroenterology, Hepatology and Nutrition Section, Children's Hospital Colorado, Aurora, CO. The team presented the PedsOL survey to 159 children with newly diagnosed celiac disease, and their parents, at either the time of diagnostic duodenoscopy, or prior to their first dietitian appointment for gluten-free diet instruction. The team calculated average parent-report and self-report PedsQL summary and sub-scale scores, then used 1-sample tests to compare to documented averages from a group of healthy children, and a group of children with non-celiac gastrointestinal symptoms. Compared to the healthy kids, those newly diagnosed celiac disease had lower Total Scores, Physical Health, Psycho-social Health, Emotional Functioning, and School Functioning on parent report with similar findings on self-report. Among kids and adolescents with celiac disease, the team found clinically significant scores in nearly 56% for School Functioning, nearly 63% for Physical Health, about 54% for Emotional Functioning, nearly 44% for Social Functioning, and 49% for Total Score. Quality of life scores were lower for kids and adolescents with newly diagnosed celiac disease than for healthy children, and more in line with QOL for patients with non-celiac GI conditions. The team points out that kids with lower QOL scores in areas like school or emotional function might be helped with early interventions, including a Section 504 plan or meeting with a psychologist or social worker. Children and adolescents with celiac disease, and non-celiac gluten sensitivity, face extra challenges with academic or emotional well-being. Catching those extra alleges early can help those kids to get the help they need to thrive. Read more in the Journal of Pediatric Gastroenterology and Nutrition

Celiac.com 10/05/2017 - Recent data show that more adults with celiac disease may face a higher risk for cardiovascular disease compared with the general population. A team of researchers recently set out to investigate the association of with cardiovascular disease risk factors at late adolescence in a cross-sectional population-based study. The research team included Assa A, Frenkel-Nir Y, Tzur D, Katz LH, and Shamir R. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petah-Tikva; the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, and with the Medical Corps of the Israeli Defense Force. The study group included 2,001,353 Jewish Israeli adolescents who underwent general health examinations from 1988 to 2015. The average participant age was 17.1 years of age. Additional participant information included demographic measures, blood pressure, resting heart rate, and risk factors associated with cardiovascular disease. The team identified a total of 10,566 cases of celiac disease. They conducted multivariate analysis that showed average diastolic blood pressure to be significantly lower in celiac patients; 72.0±8.7 in celiac men vs 70.4 ±â€Š8.5 in non-celiac men; and 70.0 ±â€Š8.3 in celiac women vs 69.0 ±â€Š8.2 in non-celiac women. There were no differences in systolic blood pressure, while resting heart rate was slightly higher in celiac patients, with an absolute difference of 0.4 beats per minute. The team saw no increase in blood pressure, or in rates of overweight and obesity among celiac patients. Patients with celiac disease far more likely to have non-insulin-dependent diabetes mellitus, hypercoagulability, and hyperlipidemia, than were non-celiacs. By age 17, people with celiac disease have a higher prevalence of risk factors for cardiovascular disease compared with the general population. There is, however, neither increase in blood pressure nor increase in overweight and obesity rates. Source: J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):190-194. doi: 10.1097/MPG.0000000000001487.

Celiac.com 03/20/2017 - Researchers really do not have really good data on rates of celiac disease in the general population of children in the United States. A team of researchers recently set out to estimate the cumulative incidence of celiac disease in adolescents born in the Denver metropolitan area. The research team included Edwin Liu, Fran Dong, MS, Anna E. Barón, PhD, Iman Taki, BS, Jill M. Norris, MPH, PhD, Brigitte I. Frohnert, MD, PhD, Edward J. Hoffenberg, MD, and Marian Rewers, MD, PhD. Their team collected data on HLA-DR, DQ genotypes of 31,766 infants, born from 1993 through 2004 at St. Joseph’s Hospital in Denver, from the Diabetes Autoimmunity Study in the Young. For up to 20 years, the researchers followed subjects with susceptibility genotypes for celiac disease and type 1 diabetes for development of tissue transglutaminase autoantibodies (tTGA). The team was looking for patients who developed either celiac disease autoimmunity (CDA) or celiac disease, and they defined CDA as persistence of tTGA for at least 3 months or development of celiac disease. Marsh 2 or greater lesions in biopsies or persistent high levels of tTGA, indicated celiac disease. For each genotype, the team assessed cumulative incidence of CDA and celiac disease. To estimate the cumulative incidence in the Denver general population, they weighted outcomes by each genotype, based on the frequency of each of these genotypes in the general population. They found that, of 1.339 patients they studied, 66 developed CDA and met criteria for celiac disease, while 46 developed only CDA. Seropositivity for tTGA resolved spontaneously, without treatment, in 21 of the 46 patients with only CDA (46%). The team estimated the total incidence for CDA in the Denver general population at 5, 10, and 15 years of age was 2.4%, 4.3%, and 5.1% respectively; incidence values for celiac disease were 1.6%, 2.8%, and 3.1%, respectively. This 20-year prospective study of 1.339 children with genetic risk factors for celiac disease showed the total incidence of CDA and celiac disease to be high within the first 10 years. Although more than 5% of children may experience a period of CDA, that is, persistently high celiac autoantibodies, not all of them develop celiac disease or require gluten-free diets. Sources: Gastroenterology.DOI: http://dx.doi.org/10.1053/j.gastro.2017.02.002 gastrojournal.org

Celiac.com 01/04/2017 - A team of researchers recently set out to investigate the impact of celiac disease diagnosis on anthropometric measures at late adolescence, and to assess trends in the prevalence of diagnosed celiac disease over time. The research team included Amit Assa, Yael Frenkel-Nir, Ya'ara Leibovici-Weissman, Dorit Tzur, Arnon Afek, Lior H Katz, Zohar Levi, and Raanan Shamir. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach Tikva, Israel, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, the Medical Corps of the Israel Defense Forces, Ramat-Gan, Israel, the Institute of Gastroenterology, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel, and with the Ministry of Health in Jerusalem, Israel. Around 17 years of age, most of the Israeli Jewish population undergoes a general health examination, before enlistment in the Defense Forces. Individual medical information, diagnoses, etc., are entered into a structured database. For their population based study, the research team reviewed the enlistment data base for celiac disease cases between the years 1988 and 2015. In all, the team reviewed the medical records of 2,001,353 individuals, focusing on body measurements and physical health at the age of 17 years. Overall, they found and assessed 10,566 cases of celiac disease (0.53%). Multivariable analysis showed that adolescent boys with celiac disease were leaner (Body Mass Index 21.2±3.7 vs 21.7±3.8, p=0.02), while girls with celiac disease were shorter (161.5±6 cm vs 162.1±6 cm, p=0.017) than the general population. The prevalence of diagnosed celiac disease increased from 0.5% to 1.1% in the last 20 years, mainly among females, who saw a rise of 0.64% vs 0.46% for males. Celiac disease rates were far lower in people of lower socioeconomic status, and those of African, Asian and former Soviet Union origin. However, the clinical relevance of the small differences suggests that when celiac disease is diagnosed during childhood, final weight and height are not severely impaired. The team's cohort supports an observed rise in celiac disease diagnoses in the last couple of decades. Source: Arch Dis Child doi:10.1136/archdischild-2016-311376

Celiac.com 08/02/2013 - A great deal of effort goes into determining the best procedures for screening for celiac disease. Ideally it would be great to test everyone, but that is currently too expensive on such a large scale. So, one of the things researchers study is how to get the best results with limited resources. To better understand the cost-effectiveness of universal screening for celiac disease versus screening only patients who are at risk for or showing symptoms of celiac disease, a team of researchers looked specifically at the high risk, and associated costs, of non-traumatic hip and vertebral fractures if celiac disease is untreated or undiagnosed. Their results appear in Clinical Gastroenterology and Hepatology. The team found that the current standard practice of screening adolescents who are either symptomatic or at high-risk for celiac disease proves to be more cost-effective than universal screening. They also found that screening helps to prevent decreased bone mineral density, which can affect up to 70 percent of untreated celiac patients, and often leads to osteoporosis and non-traumatic hip and vertebral fractures. Overall, blanket screening and selective screening both had similar lifetime costs and quality of life ratings, but screening only those at risk or with actual symptoms proved to be more cost effective in preventing bone loss and fractures among patients with undiagnosed or subclinical celiac disease. They noted that additional analyses looking at risk and cost of other potential consequences of undiagnosed and untreated celiac disease, such as anemia, infertility and malignancy, might change the cost-effectiveness balance more in favor of universal screening for celiac disease. Source: American Gastroenterological Association