Background and aims: Lifelong Adherence to a gluten-free diet (GFD) is the sole treatment for celiac disease (CeD). Disordered eating patterns may influence dietary compliance and clinical outcomes. We assessed the prevalence of eating disorders (ED) in adults with CeD and its association with adherence to GFD.
Patients and Methods: In this cross-sectional study, adult patients with biopsy-proven CeD (n=262) and age- and sex-matched controls (n=120) were assessed using the Eating Attitudes Test-26 (EAT-26), Celiac Dietary Adherence Test (CDAT), and Celiac Disease Compliance Assessment Test (CDCAT). EAT-26 ≥22 and a combination of EAT-26 ≥22, Patient Health Questionnaire-9 (PHQ-9) ≥10, and Generalised Anxiety Disorder-7 (GAD-7) were used to represent ED symptoms and probable eating disorder, respectively. CDAT/CDCAT scores were used to classify GFD adherence.
Results: ED symptoms and probable ED were present in 42 (16.4%) and 13 (4.9%) patients with CeD, significantly higher than matched controls [4 (3.3%) and 0 (0.0%), respectively; p<0.01 for both]. Patients with CeD had similar demographic and laboratory parameters irrespective of the presence of ED symptoms or probable ED. Patients with probable ED had similar median CDAT (7.50 [7.00, 8.25] vs 7.00 [7.00, 8.00]; p=0.98) and CDCAT scores (14.50 [13.00, 16.25] vs 15.00 [13.00, 15.00]; p=0.75) as those without ED at baseline, and their adherence scores improved inadequately with dietary advice alone.
Conclusion: Disordered eating behaviours are common in adult patients with CeD and their recognition is essential to optimise the administration of GFD to them. These patients could benefit from early multidisciplinary care, including dietary, psychological and medical interventions.