Disordered Eating Behaviors Identified in Adults with Celiac Disease

Disordered eating behaviors were more common among those with untreated celiac disease.

About 1 in 100 adults in the western world is affected by celiac disease, a chronic inflammatory immune gut disease that can cause a wide variety of gastrointestinal and extra-gastrointestinal symptoms. Celiac disease also involves intolerance to the protein gluten, found in wheat, barley, oats, rice, and malt. A study conducted is two Italian cities is the first to show the presence of altered eating behaviors among adults with untreated celiac disease (Gastroenterology Research and Practice. 2013; 491617). Dr. V. Passananti and colleagues at the University Federico II of Naples and the University of Salerno, Italy, designed the case-control study to investigate a possible relationship between emotional-psychological factors in untreated celiac disease and the presence of an eating disorder.

From January 2011 to January 2012, 100 adult patients (72 women, 28 men) with untreated celiac disease and 100 healthy control individuals (68 women, 32 men) were recruited for the study. All participants were between 18 and 60 years of age. The researchers collected clinical information and measured body mass index (BMI). Subjects completed a structured psychological assessment and were scored on 7 questionnaires, including the EPIC Food Frequency Questionnaire, Binge Eating Staircases (BES), the Eating Attitudes Test, the Eating Disorder Inventory (EDI-2), measures to grade depression and anxiety, and the Symptom Check List (SCL-90).

Lower BMIs, higher EAT-26 scores

Patients with celiac disease had significantly lower BMIs and more frequent gastrointestinal symptoms than did the healthy controls. The two groups were very similar in all other regards, including level of physical activity, alcohol intake, food intake, and BES scores.

The EAT-26 showed very different results. The celiac group had significantly higher mean EAT-26 scores than did the healthy controls. In addition, the percentage of pathological EAT-26 scores was significantly different between the celiac and healthy controls: 16% vs. 4%, respectively; P=0.01).

On the EDI-2, compared to the healthy controls, women with celiac disease had significant differences on several items, such as drive for thinness, social insecurity, perfectionism, feelings of inadequacy, and interpersonal diffidence. When these were taken together, they pointed to a trend to a strong concern about body image and food intake. The picture was quite different for men with celiac disease: the only difference from healthy control men was for interceptive awareness. Global and pathological scores from the SCL-90 were significantly different between the two study populations.

These findings indicated that the altered eating behavior is more common among persons with untreated celiac disease than among healthy controls. Bulimic behavior was found only among men with celiac disease, and untreated men and women with celiac disease reported higher daily carbohydrate intake than did healthy controls. The authors noted that this finding may support the hypothesis that high-gluten intake occurs before the onset of celiac disease among persons who are genetically predisposed to the disease.

The results of this study reinforce the importance of testing for disordered eating in people with celiac disease.