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J Hum Nutr Diet. 2019 Jun;32(3):311-320. doi: 10.1111/jhn.12638. Epub 2019 Mar 5.

Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten-free diet: a cross-sectional, mixed-methods study.

Author information

1
Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA.
2
Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA.
3
Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
4
Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, King's College London, London, UK.

Abstract

BACKGROUND:

Certain approaches to managing a strict gluten-free diet (GFD) for coeliac disease (CD) may lead to impaired psychosocial well-being, a diminished quality of life (QOL) and disordered eating. The present study aimed to understand adolescents' approaches to managing a GFD and the association with QOL.

METHODS:

Thirty adolescents with CD (13-17 years old) following the GFD for at least 1 year completed the Celiac Dietary Adherence Test (CDAT) and QOL survey. Their approaches to GFD management were explored using a semi-structured interview, where key themes were developed using an iterative process, and further analysed using a psychosocial rubric to classify management strategies and QOL. CDAT ratings were compared across groups.

RESULTS:

Gluten-free diet management strategies were classified on a four-point scale. Adaptive eating behaviours were characterised by greater flexibility (versus rigidity), trust (versus avoidance), confidence (versus controlling behaviour) and awareness (versus preoccupation) with respect to maintaining a GFD. Approximately half the sample (53.3%) expressed more maladaptive approaches to maintaining a GFD and those who did so were older with lower CD-Specific Pediatric Quality of Life (CDPQOL) scores, mean subscale differences ranging from 15.0 points for Isolation (t = 2.4, P = 0.03, d.f. = 28) to 23.4 points for Limitations (t = 3.0, P = 0.01, d.f. = 28).

CONCLUSIONS:

Adolescents with CD who manage a GFD with maladaptive eating behaviours similar to known risk factors for feeding and eating disorders experience diminished QOL. In accordance with CD management recommendations, we recommend ongoing follow-up with gastroenterologists and dietitians and psychosocial support referrals, as needed.

KEYWORDS:

childhood eating behaviours; coeliac disease; eating disorders; quality of life

PMID:
30834587
PMCID:
PMC6467807
[Available on 2020-06-01]
DOI:
10.1111/jhn.12638

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