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Celiac.com 01/03/2025 - Celiac disease, a chronic immune-mediated condition triggered by gluten consumption, has historically been associated with gastrointestinal symptoms. However, as diagnostic methods improve, the disease is increasingly identified in older adults. While celiac disease in younger populations has been studied extensively, limited research has explored its long-term complications in older individuals. Frailty—a state of increased vulnerability to adverse health outcomes—is a critical concern in aging populations. This study aimed to evaluate the relationship between celiac disease and frailty in adults aged 60 years and older, using a large nationwide cohort in Sweden. Research Methods The study utilized Swedish national health records to identify adults aged 60 and older who were newly diagnosed with celiac disease between 2004 and 2017. Each individual with celiac disease was matched to population-based controls without the disease, ensuring comparability by age, sex, location, and calendar year. The primary analysis focused on baseline frailty within three years before the diagnosis of celiac disease or the corresponding index date for controls. Frailty was assessed using the Hospital Frailty Risk Score, a validated tool that categorizes individuals into low, intermediate, and high-risk frailty levels. Among those without frailty at baseline, the researchers assessed the likelihood of developing frailty over a five-year period. Additionally, they investigated whether achieving mucosal healing—evidence of intestinal recovery—on follow-up biopsies influenced the risk of future frailty. Key Findings Baseline Frailty Before Diagnosis The analysis included 4,646 older adults with celiac disease and 21,944 matched controls. Frailty at baseline was significantly more common among individuals with celiac disease compared to controls, with 54.4% of celiac disease patients exhibiting frailty versus 29.7% of controls. This pattern held true across all frailty categories: Low-risk frailty: 43.4% in celiac patients versus 23.8% in controls. Intermediate-risk frailty: 10.3% in celiac patients versus 5.4% in controls. High-risk frailty: 0.8% in celiac patients versus 0.6% in controls. Increased Risk of Frailty Over Time Among individuals without frailty at baseline, those with celiac disease had a 61% higher risk of developing frailty within five years compared to their matched counterparts. This heightened risk was consistent across the study population, highlighting the sustained vulnerability associated with celiac disease even after initial diagnosis. Impact of Mucosal Healing The study also explored whether achieving mucosal healing, as confirmed by follow-up intestinal biopsies, reduced the likelihood of frailty in celiac disease patients. Interestingly, no protective effect was observed. Whether or not individuals showed evidence of intestinal recovery, their risk of frailty remained elevated compared to the general population. This finding suggests that factors beyond intestinal inflammation, such as systemic inflammation or nutritional deficiencies, may contribute to the development of frailty in celiac disease. Discussion The results of this study underscore the significant impact celiac disease can have on overall health and well-being, particularly in older adults. Even before diagnosis, individuals with celiac disease were more likely to exhibit signs of frailty, which may be linked to long-standing nutritional deficiencies, chronic inflammation, or undiagnosed symptoms. Post-diagnosis, the heightened risk of frailty persisted, indicating that managing celiac disease with a strict gluten-free diet may not fully mitigate its broader health effects. The lack of a protective benefit from mucosal healing is particularly noteworthy. While intestinal recovery is often considered a marker of successful treatment in celiac disease, this study suggests that it may not be sufficient to address all systemic risks. This finding highlights the need for comprehensive management strategies that extend beyond diet to address factors like bone health, muscle strength, and overall resilience. Conclusion and Implications This study provides compelling evidence that older adults with celiac disease face a significantly higher risk of frailty compared to their peers without the condition. Frailty, in turn, is associated with greater susceptibility to adverse health outcomes, including falls, hospitalizations, and decreased quality of life. These findings emphasize the importance of early diagnosis and proactive management of celiac disease in older adults to mitigate its long-term impacts. For individuals with celiac disease, the study highlights the need for holistic care approaches that go beyond a gluten-free diet. Regular assessments of nutritional status, bone density, and physical function may help reduce the risk of frailty and improve overall health outcomes. By shedding light on the broader implications of celiac disease, this research underscores the importance of tailored care strategies for aging populations affected by the condition. Read more at: journals.lww.com

Celiac.com 11/11/2023 - In a recent poll conducted by Celiac.com, participants were tested on their knowledge of gluten-free accommodations in various settings, shedding light on the prevailing misconceptions surrounding celiac disease and U.S. regulations. The results revealed a surprising divergence of opinions, indicating a need for clarity on the legal obligations of public schools, elderly care facilities, and airlines when it comes to providing gluten-free options. While some respondents demonstrated a solid understanding of the existing regulations, a significant number seemed to be navigating a web of misinformation. In this article, we delve into the poll findings, dissecting the nuances of U.S. laws to offer a comprehensive guide on what individuals with celiac disease can truly expect in terms of gluten-free provisions. From classrooms to care facilities to the friendly skies, we aim to dispel the myths and provide an accurate portrayal of the rights and responsibilities involved in accommodating gluten-free needs. Survey Snapshot: Unveiling Perceptions and Realities of Gluten-Free Accommodations In a recent poll conducted by Celiac.com, participants were quizzed on their understanding of gluten-free accommodations within various sectors in the United States. The results revealed intriguing disparities between public perception and actual regulations. Below are the poll questions, and results, and the correct response is bolded. Public schools must provide gluten-free meals to kids with celiac disease. True: 55% False: 45% Elderly care facilities must provide gluten-free meals to residents with celiac disease. True: 68% False: 32% Airlines must provide gluten-free snacks or meals to customers with celiac disease. True: 36% False: 64% These numbers not only shed light on the prevailing beliefs but also underscore the need for greater awareness regarding the rights and expectations of individuals with celiac disease. A Deep Dive into the Poll and the Americans with Disabilities Act (ADA) Under the ADA, are public schools required to provide gluten-free meals to students with celiac disease? The Americans with Disabilities Act (ADA) does not specifically require public schools to provide gluten-free meals to students with celiac disease. However, under the ADA, public schools are required to provide reasonable accommodations to ensure that students with disabilities have equal access to educational programs and activities. This could include dietary accommodations for students with celiac disease. In practice, some public schools choose to offer gluten-free meal options to accommodate students with celiac disease. The decision to provide gluten-free meals may depend on factors such as the number of students with dietary needs, available resources, and the school's commitment to ensuring equal access for all students. If you have a child with celiac disease who requires a gluten-free diet, it's advisable to work with the school to discuss your child's specific dietary needs and explore potential accommodations. This may involve collaborating with the school's food service provider and providing documentation from a healthcare professional to support the request for gluten-free meals. It's important to note that Section 504 of the Rehabilitation Act of 1973, which applies to schools that receive federal funding, may also require schools to provide dietary accommodations for students with disabilities, including those with celiac disease. It's recommended to work closely with your child's school and healthcare professionals to ensure that their dietary needs are met. Under the ADA are public or private elderly care facilities required to provide gluten-free meals to residents with celiac disease? Under the Americans with Disabilities Act (ADA), public and private elderly care facilities are generally required to provide reasonable accommodations to meet the dietary needs of residents or patients with celiac disease. The ADA prohibits discrimination on the basis of disability, and celiac disease is considered a disability under the ADA. In the context of elderly care facilities, this means that if a resident or patient has celiac disease and requires a gluten-free diet for their health, the facility should make reasonable accommodations to provide gluten-free meals or ensure that the resident's dietary needs are met. This may include offering gluten-free menu options, ensuring proper food preparation to prevent cross-contamination, and working with healthcare professionals to address specific dietary needs. It's important for individuals with celiac disease or their family members to communicate their dietary needs with the staff at the elderly care facility, provide any necessary documentation or medical information, and collaborate with the facility to develop a dietary plan that meets their needs while complying with the ADA. Facilities should be willing to work with residents and patients to ensure their health and well-being, and the ADA requires them to make reasonable accommodations to achieve this goal. However, the specific accommodations and processes may vary depending on the facility and the individual's needs. Under the ADA are commercial required to provide gluten-free meals to passengers with celiac disease? Under the Americans with Disabilities Act (ADA), commercial airlines are not explicitly required to provide gluten-free meals to passengers with celiac disease. The ADA primarily focuses on non-discrimination and equal access for individuals with disabilities in various aspects of public life, including transportation. While airlines must ensure equal access to air travel, dietary requirements, such as gluten-free meals, fall under a different set of regulations and practices. However, many commercial airlines do offer special dietary accommodations, including gluten-free meals, as part of their in-flight services. Passengers with dietary restrictions, including those with celiac disease, can typically request special meals when making their reservations or by contacting the airline's customer service. Airlines often offer options like gluten-free, vegetarian, vegan, or other special dietary meals to accommodate passenger preferences and requirements. It's important for passengers with celiac disease to notify the airline about their dietary needs well in advance of their flight to ensure that the airline can make the necessary arrangements. Keep in mind that the availability and quality of gluten-free meals may vary among airlines, so it's a good idea to inquire about specific accommodations when booking your flight. Passengers with dietary restrictions should check with the airline they plan to travel with to understand their specific policies and options for special meals. Final Analysis: Navigating Dietary Needs Under the ADA The poll results underscore widespread misconceptions regarding gluten-free accommodations under the Americans with Disabilities Act (ADA). While a significant portion incorrectly believed public schools, elderly care facilities, and airlines were obliged to provide gluten-free options, the reality is more nuanced. Public Schools: Public schools, although not explicitly mandated by the ADA, may choose to provide gluten-free meals as a reasonable accommodation. Successful advocacy for such accommodations involves collaborative efforts between parents, schools, and healthcare professionals. Elderly Care Facilities: In the realm of elderly care, the ADA necessitates reasonable accommodations for residents with celiac disease. Clear communication, documentation, and collaboration between residents and facility staff are pivotal in ensuring compliance with ADA standards. Commercial Airlines: Contrary to popular belief, commercial airlines aren't explicitly required by the ADA to furnish gluten-free meals. However, proactive communication with airlines can often result in suitable accommodations, emphasizing the importance of early notification and thorough understanding of each airline's policies. Empowering Individuals: This analysis reveals the need for improved awareness and understanding of ADA provisions related to dietary accommodations. Individuals with celiac disease and their advocates play a crucial role in fostering effective communication and collaboration to ensure their needs are met. While the ADA provides a framework for reasonable accommodations, it's essential to recognize the distinctions in how it applies to different settings. Navigating the landscape of gluten-free requirements involves proactive engagement, effective communication, and a collaborative approach between individuals, institutions, and healthcare professionals. As awareness grows, it is hoped that misconceptions will dissipate, fostering an environment where individuals with celiac disease can confidently assert their rights and enjoy equal access to various facets of public life. Source: Americans with Disabilities Act Title II Regulation

Celiac.com 11/28/2016 - It's clear from research data that what was once thought to be a childhood disease can affect people well into adulthood and old age. A team of researchers recently set out to assess rates of celiac disease diagnosis in an elderly population, recording the main clinical features of this group respect to young patients. The research team included R. Tortora, F. Zingone, A. Rispo, C. Bucci, P. Capone, N. Imperatore, N. Caporaso, D. D'Agosto, and C. Ciacci. They are variously affiliated with the Department of Clinical Medicine and Surgery at the University "Federico II" of Naples in Napes, Italy, and with the Department of Gastroenterology at the University of Salerno in Salerno, Italy. They conducted a retrospective analysis of celiac disease rates in elderly individuals from 1970 to 2015. They divided patients by age into three groups. Group A included patients 18-34 years old. Group B included patients 35-64 years old. Group C included patients 65 years or older. The team then compared the groups regarding baseline anthropometric and serological variables, clinical features at diagnosis, diagnostic mode, associated autoimmune diseases, and celiac-related neoplastic complications. They made a total of 2,812 celiac disease diagnoses in adults, 2.5% of which occurred in patients 65 years or older at diagnosis. When comparing the three groups, they found no differences in sex, haemoglobin, serum iron, albumin, and anti-tissue transglutaminase (anti-tTG) (p = NS). They did find higher values of cholesterol, glycemia, and triglycerides in older patients (p < 0.0001). Elderly had higher rates of diagnosis for malabsorption symptoms compared to younger patients (OR 2.20, 95%CI 1.3-3.74). The team also found no difference in the risk of autoimmune celiac-related diseases between groups. The researchers found 16 neoplastic complications, 13 of them in patients diagnosed with celiac disease between 35-64 years of age. The number of celiac disease diagnoses increased over time, particularly in elderly. These results show that celiac disease diagnosis in the elderly population is uncommon, but not rare. Elderly celiac patients face a greater risk of being diagnosed with malabsorption symptoms than younger patients, but with a lowr risk of autoimmune and neoplastic complications. Source: Scand J Gastroenterol. 2016 Oct;51(10):1179-83. doi: 10.1080/00365521.2016.1186222. Epub 2016 May 31.

Celiac.com 09/28/2016 - Celiac disease occurs most often in children and young adults. However, people can develop celiac disease at any age, and rates are rising even among older people. Because older people often show clinically atypical symptoms, they can sometimes experience a delay in diagnosis. Also, serological tests have a lower sensitivity and specificity in the older patients. This means that doctors only begin to suspect celiac disease in the presence of other, often vaguely associated complications, such as autoimmune disorders, fractures, and finally, malignancy, and that diagnosis must be aided by endoscopic and imaging tools. A team of researchers recently set out to assess the incidence and prevalence of celiac disease in the elderly, the patterns of clinical presentation, diagnosis, and the most frequent complications, with the aim of increasing awareness and reducing the diagnostic delay of celiac disease even in the elderly population. The research team included Maria Cappello, Gaetano C. Morreale, and Anna Licata of the Gastroenterology and Hepatology Section, DIBIMIS, University of Palermo School of Medicine, Palermo, Italy. The team's recent article highlights their findings regarding celiac rates and incidence in older patients, along with patterns of clinical presentation, diagnosis, and most frequent complications. The researchers conclude: "Despite a paucity of symptoms, such as diarrhea and weight loss, celiac disease has been increasingly recognized in the elderly. Other presentations in the elderly age group include iron deficiency anemia (often refractory to oral iron), autoimmune disorders, bone disease due to osteopenia, including fractures, malignant intestinal disease, especially lymphoma, and finally idiopathic dilated cardiomyopathy. Diagnosis may be delayed due to limited symptoms, a low index of clinical suspicion, or diagnostic difficulties related to important cognitive impairment that often affects elderly people. Although for these patients, the GFD is the key of clinical management, elderly patients sometimes are scarcely adherent to diet. Patients should be referred to specialists to ensure the better management of the disease and related complications. Micronutrients, such as iron, calcium, vitamin D supplementation, and vitamins, should be part of a modified GFD for the elderly patients. All other therapeutical interventions that limit malabsorption and avoid complications should be considered part of a management strategy." Source: Clin Med Insights Gastroenterol. 2016; 9: 41–49. doi: 10.4137/CGast.S38454 PMCID: PMC4965017