Disordered Eating Attitudes and Behaviors in Individuals with Celiac Disease and the association with Quality of Life

The only treatment for celiac disease (CeD), an autoimmune disorder triggered by the ingestion of gluten, is lifelong adherence to a gluten-free diet (GFD). CeD and the GFD have been shown to be associated with low quality of life (QoL). In some individuals, such a strict diet can lead to disordered eating attitudes and behaviors. The purpose of this study was to better understand the extent to which disordered eating attitudes and behaviors may be common in a sample of adults diagnosed with CeD, as well as the relationship with various factors and QoL measures, including anxiety and depression. The study is a cross sectional pilot study of 50 individuals with CeD. Patients between the ages of 18 to 45 years old (mean=29.56, SD=7.40) with a biopsy-proven CeD diagnosis, following a GFD for at least a year (mean=7.20, SD=5.31) with no previous or current eating disorder diagnosis were recruited. In this study, suggestive ED (based on EDDS) and DE (based on EPSI) were present, but low (2% suggestive diagnosis of BED, 12% suggestive diagnosis of OSFED as per DSM-V). The distribution of the self-reported food attitudes and behaviors measures (CD-FAB scores) were spread out around the mean 36.96 (15.30) with a maximum score of 66 out of a possible 77. The CD-FAB may have utility in identifying adults with CeD that may be at risk for disordered eating attitudes and behaviors, particularly those in the first few years after diagnosis. It likely has limited utility in identifying suggestive EDs (as per EDDS) and DE (as per EPSI). The main factors that were associated with higher CD-FAB scores were BMI, number of symptoms, years since diagnosis, diet adherence and personality characteristics. Seven years after diagnosis seems to be an important cut-point in how participants rated food attitudes, fear responses and adaptive responses on the CDFAB scales. Higher CD-FAB scores had a significant and meaningful association with QoL scores. Participants recruited during the COVID-19 pandemic had significantly lower CD-FAB scores and higher QoL scores compared to those recruited pre-pandemic; despite not having significant differences in any other demographic characteristics.