1
|
Elwenspoek M, Banks J, Desale PP, Watson J, Whiting P. Exploring factors influencing quality of life variability among individuals with coeliac disease: an online survey. BMJ Open Gastroenterol 2024; 11:e001395. [PMID: 38830687 DOI: 10.1136/bmjgast-2024-001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/21/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Patients with coeliac disease (CD) need to follow a strict gluten-free diet to manage symptoms and prevent complications. Restrictions imposed by the diet can be challenging and affect quality of life (QoL). We explored sources of variation in QoL among patients with CD. DESIGN We conducted an online survey of coeliac patients in the UK, including a CD-specific QoL tool (CD-QOL V.1.0), questions on diet adherence and an optional comment box at the end. The survey was disseminated via social media and went live between January and March 2021. We performed multiple linear regression and free text analysis. RESULTS We found a median CD-QOL score of 61 (IQR 44-76, range 4-100, n=215) suggesting good QoL (Good >59); however, the individual QoL scores varied significantly. Regression analyses showed that people who found diet adherence difficult and people adhering very strictly had a lower QoL. Free text comments suggested that people who adhered very strictly may do so because they have symptoms with minimal gluten exposure. People who found diet adherence difficult may be people who only recently started the diet and were still adjusting to its impact. Comments also highlighted that individuals with CD often perceive a lack of adequate follow-up care and support after diagnosis. CONCLUSION Better support and follow-up care is needed for people with CD to help them adjust to a gluten-free diet and minimise the impact on their QoL. Better education and increased awareness are needed among food businesses regarding cross-contamination to reduce anxiety and accidental gluten exposure.
Collapse
Affiliation(s)
- Martha Elwenspoek
- University of Bristol Population Health Sciences, Bristol, UK
- NIHR ARC West, Bristol, UK
| | - Jonathan Banks
- University of Bristol Population Health Sciences, Bristol, UK
- NIHR ARC West, Bristol, UK
| | | | - Jessica Watson
- University of Bristol Population Health Sciences, Bristol, UK
- NIHR ARC West, Bristol, UK
| | - Penny Whiting
- University of Bristol Population Health Sciences, Bristol, UK
| |
Collapse
|
2
|
Falcomer AL, de Lima BR, Farage P, Fabris S, Ritter R, Raposo A, Teixeira-Lemos E, Chaves C, Zandonadi RP. Enhancing life with celiac disease: unveiling effective tools for assessing health-related quality of life. Front Immunol 2024; 15:1396589. [PMID: 38742113 PMCID: PMC11089154 DOI: 10.3389/fimmu.2024.1396589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Celiac disease (CD) is an autoimmune chronic enteropathy provoked by gluten ingestion in genetically predisposed individuals. Considering it´s only safe treatment is a lifelong gluten-free diet, the burden of living with the disease becomes evident, as well as the need to assess CD health-related quality of life (HRQOL). This review aims to identify and analyze the instruments used to evaluate the HRQOL of adults with CD. This integrative review using a systematic approach was designed to achieve high scientific standards. Accordingly, the search strategy was developed and executed as recommended by the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Detailed individual searches were developed to Pubmed, Science Direct, Scopus, Web of Science, and Google Scholar. After careful analysis of the papers, 43 studies were included, in which seven instruments were identified: Celiac Disease Questionnaire (CDQ) (n=21), Celiac Disease Specific Quality of Life Instrument (CD-QOL) (n=17), Celiac Disease Assessment Questionnaire (CDAQ) (n=4), CeliacQ-7 (n=1), CeliacQ-27 (n=1), Black and Orfila´s self-developed instrument (n=1) and the Coeliac Disease Quality of Life Questionnaire (CDQL) (n=1). The CDQ and CD-QOL were the two most applied instruments. Since the first focuses on the physical and mental symptoms related to the disease and the second focuses on the emotional repercussions of adhering to the GFD treatment for life (dysphoria), the CDQ application is an interesting option for countries that struggle with public policies for CD patients and patients with active CD. The CD-QOL could be used for countries with strict regulations for CD and gluten-free products and populations in remission. When comparing results among different populations, it is preferable to utilize culturally validated instruments, which have been applied across multiple countries, providing greater comparability between study findings.
Collapse
Affiliation(s)
- Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Department of Nutrition, Centro Universitário IESB, Brasília, Brazil
| | - Bernardo Romão de Lima
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Department of Nutrition, Centro Universitário IESB, Brasília, Brazil
| | - Priscila Farage
- Faculty of Nutrition (FANUT), Federal University of Goiás, Goiânia, Brazil
| | - Samantha Fabris
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Ruth Ritter
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal
| | | | - Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, Viseu, Portugal
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| |
Collapse
|
3
|
Dochat C, Afari N, Satherley RM, Coburn S, McBeth JF. Celiac disease symptom profiles and their relationship to gluten-free diet adherence, mental health, and quality of life. BMC Gastroenterol 2024; 24:9. [PMID: 38166645 PMCID: PMC10759532 DOI: 10.1186/s12876-023-03101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A subgroup of adults with celiac disease experience persistent gastrointestinal and extraintestinal symptoms, which vary between individuals and the cause(s) for which are often unclear. METHODS The present observational study sought to elucidate patterns of persistent symptoms and the relationship between those patterns and gluten-free diet adherence, psychiatric symptoms, and various aspects of quality of life (QOL) in an online sample of adults with celiac disease. U.S. adults with self-reported, biopsy-confirmed celiac disease (N = 523; Mage = 40.3 years; 88% women; 93.5% White) voluntarily completed questionnaires as part of the iCureCeliac® research network: (a) Celiac Symptoms Index (CSI) for physical symptoms and subjective health; (b) Celiac Dietary Adherence Test for gluten-free diet adherence; (c) PROMIS-29, SF-36, and Celiac Disease Quality of Life Survey for psychiatric symptoms and QOL. Symptom profiles were derived using latent profile analysis and profile differences were examined using auxiliary analyses. RESULTS Latent profile analysis of CSI items determined a four-profile solution fit best. Profiles were characterized by: (1) little to no symptoms and excellent subjective health (37% of sample); (2) infrequent symptoms and good subjective health (33%); (3) occasional symptoms and fair to poor subjective health (24%); (4) frequent to constant symptoms and fair to poor subjective health (6%). Profiles 2 and 3 reported moderate overall symptomology though Profile 2 reported relatively greater extraintestinal symptoms and Profile 3 reported relatively greater gastrointestinal symptoms, physical pain, and worse subjective health. Profiles differed on anxiety and depression symptoms, limitations due to physical and emotional health, social functioning, and sleep, but not clinical characteristics, gluten-free diet adherence, or QOL. Despite Profile 3's moderate symptom burden and low subjective health as reported on the CSI, Profile 3 reported the lowest psychiatric symptoms and highest quality of life on standardized measures. CONCLUSIONS Adults with celiac disease reported variable patterns of persistent symptoms, symptom severity, and subjective health. Lack of profile differences in gluten-free diet adherence suggests that adjunctive dietary or medical assessment and intervention may be warranted. Lower persistent symptom burden did not necessarily translate to better mental health and QOL, suggesting that behavioral intervention may be helpful even for those with lower celiac symptom burden.
Collapse
Affiliation(s)
- Cara Dochat
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California San Diego, La Jolla, CA, USA
| | | | - Shayna Coburn
- Children's National Health System, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | |
Collapse
|
4
|
Lebwohl B, Ma C, Lagana SM, Pai RK, Baker KA, Zayadi A, Hogan M, Bouma G, Cellier C, Goldsmith JD, Lundin KEA, Pinto-Sanchez MI, Robert ME, Rubio-Tapia A, Sanders DS, Schaeffer DF, Semrad CE, Silvester JA, Verdú EF, Verma R, Wu TT, Feagan BG, Crowley E, Jairath V, Murray JA. Standardizing Randomized Controlled Trials in Celiac Disease: An International Multidisciplinary Appropriateness Study. Gastroenterology 2024; 166:88-102. [PMID: 37704112 DOI: 10.1053/j.gastro.2023.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND & AIMS There is a need to develop safe and effective pharmacologic options for the treatment of celiac disease (CeD); however, consensus on the appropriate design and configuration of randomized controlled trials (RCTs) in this population is lacking. METHODS A 2-round modified Research and Development/University of California Los Angeles Appropriateness Method study was conducted. Eighteen gastroenterologists (adult and pediatric) and gastrointestinal pathologists voted on statements pertaining to the configuration of CeD RCTs, inclusion and exclusion criteria, gluten challenge, and trial outcomes. Two RCT designs were considered, representing the following distinct clinical scenarios for which pharmacotherapy may be used: trials incorporating a gluten challenge to simulate exposure; and trials evaluating reversal of histologic changes, despite attempted adherence to a gluten-free diet. Each statement was rated as appropriate, uncertain, or inappropriate, using a 9-point Likert scale. RESULTS For trials evaluating prevention of relapse after gluten challenge, participants adherent to a gluten-free diet for 12 months or more with normal or near-normal-sized villi should be enrolled. Gluten challenge should be FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) free, and efficacy evaluated using histology with a secondary patient-reported outcome measure. For trials evaluating reversal of villus atrophy, the panel voted it appropriate to enroll participants with a baseline villus height to crypt depth ratio ≤2 and measure efficacy using a primary histologic end point. Guidance for measuring histologic, endoscopic, and patient-reported outcomes in adult and pediatric patients with CeD are provided, along with recommendations regarding the merits and limitations of different end points. CONCLUSIONS We developed standardized recommendations for clinical trial design, eligibility criteria, outcome measures, gluten challenge, and disease evaluations for RCTs in patients with CeD.
Collapse
Affiliation(s)
- Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Alimentiv Inc, London, Ontario, Canada.
| | - Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Rish K Pai
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | | | - Gerd Bouma
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Christophe Cellier
- Department of Gastroenterology, University of Paris-Cité, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Knut E A Lundin
- Norwegian Coeliac Disease Research Centre, University of Oslo Faculty of Medicine, Oslo, Norway; Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Maria I Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Marie E Robert
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Alberto Rubio-Tapia
- Celiac Disease Program, Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - David F Schaeffer
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Carol E Semrad
- Department of Gastroenterology, University of Chicago, Chicago, Illinois
| | - Jocelyn A Silvester
- Harvard Celiac Research Program, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Celiac Disease Center, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elena F Verdú
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ritu Verma
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago, Chicago, Illinois
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Brian G Feagan
- Alimentiv Inc, London, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Eileen Crowley
- Alimentiv Inc, London, Ontario, Canada; Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital Western Ontario, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Alimentiv Inc, London, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
5
|
Al Hayek AA, Al Zahrani WM, AlAblani HM, Al Dawish MA. Metabolic control, adherence to the gluten-free diet and quality of life among patients with type 1 diabetes and celiac disease. Diabetol Metab Syndr 2023; 15:189. [PMID: 37759325 PMCID: PMC10536816 DOI: 10.1186/s13098-023-01167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS In this cross-sectional study, we aimed to evaluate metabolic control, adherence to a gluten-free diet (GFD), and quality of life (QoL) in individuals with type 1 diabetes (T1D) and celiac disease (CD). METHODS We targeted individuals with T1D and CD at a major tertiary hospital in Saudi Arabia. We gathered retrospective data from medical records and prospectively assessed glycemic control using HbA1c and ambulatory glucose metrics, adherence to a GFD using the Celiac Dietary Adherence Test (CDAT), and QoL using the Celiac Disease Quality of Life survey (CD-QoL). RESULTS Forty-eight out of 1095 patients screened (4.38%) were included. Mean age and HbA1c were 21.3 (± 6.6) and 8.3% (± 0.8%). The average time in range% and above range% were 38.5 (range 24-68) and 29.6 (± 7.4). The median hypoglycemic events/month was 8, with a median duration of 80 min. The median overall CDAT and CD-QoL scores were 20.5 and 54. No significant correlations were observed between glucose management indicator (GMI), % in target, and CDAT/CD-QoL scores (all p > 0.05). CONCLUSIONS No significant effect of GFD on QoL or glycemic control was observed. Further prospective studies are warranted to establish solid evidence of the impact of GFD on individuals with T1D and CD.
Collapse
Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia.
| | - Wael M Al Zahrani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Hamad M AlAblani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| |
Collapse
|
6
|
Vereczkei Z, Imrei M, Szakács Z, Kővári B, Papp V, Lénárt Z, Berki T, Szirmay B, Farkas N, Balaskó M, Habon T, Hegyi P, Bajor J. Cardiovascular risk factors in coeliac disease (ARCTIC): a protocol of multicentre series of studies. BMJ Open 2023; 13:e068989. [PMID: 37709338 PMCID: PMC10503320 DOI: 10.1136/bmjopen-2022-068989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION There is only limited and controversial information available on the cardiovascular (CV) risk in coeliac disease (CD). In this study, we plan to investigate the body composition and CV risk-related metabolic parameters at the diagnosis of CD and on a gluten-free diet in a Hungarian cohort of patients with CD. METHODS AND ANALYSIS This study consists of two case-control studies and a prospective cohort study, involving newly diagnosed and treated patients with CD with age and sex-matched non-CD control subjects with an allocation ratio of 1:1. CD-related symptoms, quality of life, quality of the diet and CV risk will be assessed with questionnaires. Our primary outcomes are body composition parameters, which will be estimated with InBody 770 device. Secondary outcomes are CV-risk related metabolic parameters (eg, serum lipids, haemoglobin A1c, homeostatic model assessment index, liver enzymes, homocysteine, interleukin 6, galectin-3) and enteral hormones (leptin, ghrelin, adiponectin) measured from venous blood samples for all participants. Fatty liver disease will be assessed by transabdominal ultrasonography. In statistical analysis, descriptive and comparative statistics will be performed. With this study, we aim to draw attention to the often neglected metabolic and CV aspect of the management of CD. Findings may help to identify parameters to be optimised and reassessed during follow-up in patients with CD. ETHICS AND DISSEMINATION The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05530070.
Collapse
Affiliation(s)
- Zsófia Vereczkei
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Zsolt Szakács
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Bálint Kővári
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Veronika Papp
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Lénárt
- First Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, Medical School, University of Pecs, Pecs, Hungary
| | - Balázs Szirmay
- Department of Laboratory Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Institute of Bioanalysis, Medical School, University of Pecs, Pecs, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Tamás Habon
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Bajor
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| |
Collapse
|
7
|
Cadenhead JW, Martínez-Steele E, Contento I, Kushi LH, Lee AR, Nguyen TTT, Lebwohl B, Green PHR, Wolf RL. Diet quality, ultra-processed food consumption, and quality of life in a cross-sectional cohort of adults and teens with celiac disease. J Hum Nutr Diet 2023; 36:1144-1158. [PMID: 36653177 DOI: 10.1111/jhn.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Coeliac disease (CeD), a common autoimmune condition, requires strict adherence to a gluten-free diet (GFD). Adherence to the GFD has been associated with quality of life (QOL). However, there may be other diet-related concerns, such as overall diet patterns, including diet quality or ultra-processed food (UPF) consumption, possibly associated with QOL among people with CeD following a GFD that have not been examined. METHODS Diet quality was determined based on 24-h diet recalls of a cross-sectional prospectively recruited sample of 80 participants (50 adults and 30 teens) with biopsy-confirmed CeD ('Study Sample') using the Healthy Eating Index and Alternate Mediterranean Diet score. The amount of UPF consumed was assessed using Nova, a food processing classification system. QOL was measured using Celiac Disease-Specific Quality of Life (CDQOL) and Celiac Disease Pediatric-Specific Quality of Life (CDPQOL). The Study Sample's diet patterns were compared with National Health and Nutrition Examination Survey (NHANES) groups (25 adults reporting prior CeD and GFD; 51 adults with new CeD and no GFD; 15,777 adults and 2296 teens without CeD). The relationship of the Study Sample's diet patterns with CDQOL/CDPQOL was assessed using analysis of covariance. RESULTS The Study Sample's diet patterns were suboptimal but generally favourable compared with all NHANES groups. Compared to Study Adults with the highest tertile of UPF, those with the lowest tertile had significantly higher CDQOL (mean: 67.6 vs. 78.3, p < 0.001). Compared to Study Teens with the lowest tertile of AMED, those with the highest tertile had significantly higher CDPQOL (mean: 67.0 vs. 79.9, p < 0.01). CONCLUSIONS Maintaining high diet quality and minimising UPF may be important for CeD-specific QOL among individuals with CeD maintaining a GFD.
Collapse
Affiliation(s)
- Jennifer W Cadenhead
- Department of Health & Behavior Studies, Program in Nutrition Teachers College, Columbia University, New York, NY, USA
- Kaiser Permanente Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Euridice Martínez-Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Isobel Contento
- Department of Health & Behavior Studies, Program in Nutrition Teachers College, Columbia University, New York, NY, USA
| | - Lawrence H Kushi
- Kaiser Permanente Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Anne R Lee
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Thanh Thanh T Nguyen
- Department of Health & Behavior Studies, Program in Nutrition Teachers College, Columbia University, New York, NY, USA
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Randi L Wolf
- Department of Health & Behavior Studies, Program in Nutrition Teachers College, Columbia University, New York, NY, USA
| |
Collapse
|
8
|
Angyal MM, Lakatos PL, Jenei B, Brodszky V, Rencz F. Health utilities and willingness to pay in adult patients with coeliac disease in Hungary. Qual Life Res 2023:10.1007/s11136-023-03418-w. [PMID: 37067657 PMCID: PMC10393904 DOI: 10.1007/s11136-023-03418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Coeliac disease (CD) is a life-long food-related disorder with a global prevalence of approximately 1%. Patients with CD often experience reduced health-related quality of life that could improve with a strict adherence to a gluten-free diet (GFD). OBJECTIVES To obtain visual analogue scale (VAS), time trade-off (TTO) and willingness-to-pay (WTP) values amongst patients with CD. METHODS In 2020-2021, a cross-sectional online survey was conducted amongst 312 adult CD patients in Hungary. Patients completed the Gastrointestinal Symptom Rating Scale (GSRS) and evaluated their current health and three hypothetical health state vignettes defined based on dietary adherence using VAS, conventional 10-year TTO and WTP. Multivariate regressions were used to explore the effect of patients' demographic and clinical characteristics on utility and WTP values. RESULTS Mean VAS values for current health and 'CD with strict adherence to GFD', 'CD with loose adherence to GFD' and 'CD without GFD' hypothetical health states were 79.69 ± 18.52, 85.36 ± 16.18, 62.44 ± 19.91 and 36.69 ± 25.83, respectively. Corresponding mean TTO utilities were: 0.90 ± 0.19, 0.91 ± 0.20, 0.87 ± 0.23 and 0.76 ± 0.29. Mean annual WTP values for returning to full health were: €845 ± 1077, €648 ± 1002, €862 ± 1135 and €1251 ± 1496. Older age at diagnosis, male sex, more severe gastrointestinal symptoms (GSRS) and having comorbidities were associated with lower VAS and TTO or higher WTP values for current own health (p < 0.05). CONCLUSION This is the first study to report TTO utilities for CD health states. Strict adherence to the GFD may result in substantial health gains in symptomatic patients. Utilities and WTP results can be used to estimate benefits of GFD in cost-utility and cost-benefit analyses.
Collapse
Affiliation(s)
- M Mercédesz Angyal
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 26 Üllői út, Budapest, 1085, Hungary
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Peter L Lakatos
- McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor u. 2/a, Budapest, 1083, Hungary
| | - Balázs Jenei
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary.
| |
Collapse
|
9
|
Gholmie Y, Lee AR, Satherley RM, Schebendach J, Zybert P, Green PHR, Lebwohl B, Wolf R. Maladaptive Food Attitudes and Behaviors in Individuals with Celiac Disease and Their Association with Quality of Life. Dig Dis Sci 2023:10.1007/s10620-023-07912-6. [PMID: 37024737 PMCID: PMC10079145 DOI: 10.1007/s10620-023-07912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The only treatment for celiac disease (CeD) is strict lifelong adherence to a gluten-free diet (GFD). In some individuals the demands of a GFD may contribute to maladaptive eating attitudes and behaviors that impair quality of life (QOL). The Celiac Disease Food Attitudes and Behaviors (CD-FAB) is an easily administered and scored 11-item tool querying potentially maladaptive food attitudes and behaviors resulting from beliefs around gluten exposures and food safety. OBJECTIVES To assess the usefulness of the CD-FAB in establishing the presence of maladaptive food attitudes and behaviors among adults with CeD and to explore the relationship between these attitudes and behaviors and other factors including QOL, anxiety, depression, CeD symptoms and personality traits. METHODS The study is a cross-sectional pilot of 50 adults (mean age 29.6 years) with biopsy-proven CeD who followed a GFD for at least one year and had no self-reported eating disorder diagnosis. High scores on the CD-FAB tool suggest higher disordered eating attitudes and beliefs. RESULTS Compared to lower scores (mean 20.2), higher (worse) CD-FAB scores (mean 54.5) were positively associated with recency of diagnosis, number of CeD-related gastrointestinal symptoms, and the personality trait of neuroticism. Higher CD-FAB scores were statistically and clinically significantly associated with diminished QOL (p < 0.001). The relationship with anxiety and depression was less clear but trended in the expected direction. CONCLUSION The CD-FAB may be a useful tool for dietitians who wish to monitor maladaptive food attitudes and behaviors among their CeD patients, especially in the first-year post-diagnosis.
Collapse
Affiliation(s)
- Yara Gholmie
- Program in Nutrition, Department of Health & Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - Anne R Lee
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 934, Harkness Pavilion, New York, NY, 10032, USA
| | - Rose-Marie Satherley
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Janet Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Patricia Zybert
- Department of Health & Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 934, Harkness Pavilion, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 934, Harkness Pavilion, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th St., New York, NY, 10032, USA
| | - Randi Wolf
- Program in Nutrition, Department of Health & Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| |
Collapse
|
10
|
Niknam R, Jafari P, Safarpour AR, Shojaei-Zarghani S, Fattahi MR. Reliability, Validity, and Transcultural Adaptation of New Persian Version of Celiac Disease Quality of Life Questionnaire. Middle East J Dig Dis 2023; 15:126-132. [PMID: 37546512 PMCID: PMC10404082 DOI: 10.34172/mejdd.2023.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/29/2023] [Indexed: 08/08/2023] Open
Abstract
Background: Health-related quality of life (HRQOL) assessment in patients with celiac disease (CD) leads to understanding the impact of the CD and interventions on the individual and society. The aim of this study was transcultural adaptation and evaluation of the reliability and validity of the standardized questionnaire of celiac disease quality of life (CD-QOL) in the Persian language in southwest Iran. Methods:150 adults with CD were randomly selected from the celiac clinic and Fars Celiac Registry to complete the New Persian version of the CD-QOL questionnaire. Transcultural adaptation of the questionnaire was conducted by a four-step procedure. The internal consistency of the CD-QOL subscales and convergent and discriminant validity were assessed using Cronbach's alpha coefficient and Spearman's correlation, respectively. Construct validity was evaluated by exploratory and confirmatory factor analysis. Results: All domains of the CD-QOL questionnaire had acceptable internal consistency, showing excellent reliability. The scaling success rates for convergent and discriminant validity were also within an acceptable range (87-100%). In the factor analysis model, similar to the original English version, four factors were extracted characterizing the patients' answers (limitations, dysphoria, health concerns, and inadequate treatment). Conclusion: Our Persian version of the CD-QOL questionnaire had high reliability and validity and could be used in clinical practice assessing the CD-specific HRQOL in the Iranian population.
Collapse
Affiliation(s)
- Ramin Niknam
- Professor, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Professor, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Assistant Professor, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Shojaei-Zarghani
- Research Assistant, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Professor, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
11
|
Dochat C, Afari N, Arigo D. Psychometric validation of the celiac disease-specific quality of life survey (CD-QOL) in adults with celiac disease in the United States. Qual Life Res 2023:10.1007/s11136-023-03380-7. [PMID: 36928648 PMCID: PMC10329069 DOI: 10.1007/s11136-023-03380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Celiac disease and its treatment negatively impact quality of life, indicating potential need for measurement of disease-specific quality of life domains to inform interdisciplinary intervention. The Celiac Disease Quality of Life Survey (CD-QOL) has been used in clinical research; however, its factor structure has not been confirmed and psychometric properties have not been evaluated in English-speaking adults in the U.S. AIMS (1) Confirm the factor structure of the 20-item English CD-QOL; (2) assess psychometric properties including internal consistency reliability, convergent validity, known groups validity, and incremental validity. METHODS 453 adults with self-reported Celiac disease (Mage = 40.57; 88% female; 92% White) completed the CD-QOL and validated measures of generic health-related quality of life (SF-36), gluten-free diet adherence (CDAT), anxiety and depression symptoms (PROMIS), and physical symptoms (CSI) as part of the iCureCeliac® patient-powered research network. RESULTS Confirmatory factor analysis found superior fit for a bifactor structure with one general factor and four group factors. Ancillary bifactor analyses suggest the CD-QOL can be considered primarily unidimensional. Total and three subscale scores demonstrated acceptable internal consistency reliability. Convergent and known groups validity were supported. The CD-QOL demonstrated some incremental validity over the SF-36. CONCLUSION The English CD-QOL can be used as a measure of disease-specific quality of life among adults with Celiac disease in the U.S. Compared to generic instruments, the CD-QOL appears to better capture specific cognitive and affective aspects of living with Celiac disease. Use of a total score is recommended. Its utility as a screening and outcome measurement tool in clinical settings should be examined.
Collapse
Affiliation(s)
- Cara Dochat
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, San Diego, CA, 92120, USA.
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, San Diego, CA, USA
| | | |
Collapse
|
12
|
Systemic Diseases with Oral Manifestations and Their Impact on Health-Related Quality of Life. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
Health-related quality of life is a multidimensional concept established to evaluate the physical, psychological, and social impacts of health conditions on individuals’ well-being. Various tools for measuring health-related quality of life can be categorized into two subsets: generic and disease–specific instruments. The oral cavity can be stricken by a broad range of local and systemic diseases and their systemic treatment modalities. The most common systemic illnesses associated with oral lesions are hematologic disorders, endocrinopathies, neurological disorders, gastrointestinal conditions, mucocutaneous and rheumatic diseases, and neoplastic processes. Their manifestations in the oral cavity are, in most cases, rather nonspecific but should not be overlooked. Oral health is one of the most important parts of overall health, thus it has been proposed that poor oral health may affect health–related quality of life. The presence of oral manifestations of systemic diseases has a negative impact on the daily functioning of patients, decreasing their overall well-being. This article will review the most common systemic diseases with oral manifestations and their impact on the health–related quality of life. Oral health researchers should put a stronger emphasis on the patient-reported quality of life as a primary outcome in future clinical trials. The significance of this area has still not been widely understood in the current dental literature even though it could help improve patients’ health-related quality of life.
Collapse
|
13
|
Guennouni M, Admou B, Elkhoudri N, Bouchrit S, Ait Rami A, Bourrahouat A, Krati K, Hilali A. Quality of life of Moroccan patients with celiac disease: Arabic translation, cross-cultural adaptation, and validation of the celiac disease questionnaire. Arab J Gastroenterol 2022; 23:246-252. [PMID: 36336586 DOI: 10.1016/j.ajg.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/05/2022] [Accepted: 06/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND STUDY AIMS Celiac disease (CD) management is based on a lifelong gluten-free diet (GFD) that affects the quality of life (QoL) of patients with CD. Specific instruments have been used to evaluate this QoL, such as the CD-Questionnaire (CD-Q). This study aimed to translate, validate, and cross-culturally adapt the CD-Q in an Arabic version and then apply it to evaluate the QoL of Moroccan adult patients with CD. PATIENTS AND METHODS The Moroccan version of the CD-Q (M-CD-Q) was administered to 150 patients with CD, and 112 of them completed it. The reproducibility and reliability of the M-CD-Q were studied by the intraclass coefficient (ICC) and Cronbach's α, respectively. Parametric and nonparametric tests, confirmatory factor analysis, and Spearman correlation were used for the statistical analysis performed by SPSS, and the goodness-of-fit test was determined using SPSS AMOS. RESULTS No difficulties were found during the translation and cultural adaptation of the CD-Q. Cronbach's α showed good internal consistency. The retest showed excellent reproducibility (ICC > 0.4). The study of the psychometric properties of the M-CD-Q showed good acceptance, zero ceiling effect, and floor effect. The model fit was good [(root mean square error of approximation = 0.075 (<0.08) and χ2 = 509.04, p < 0.001]. The total scores showed a neutral QoL. This QoL was worse in the worries subscale, which is related to gluten-free products. The GFD did not improve the QoL of the examined samples. CONCLUSION The M-CD-Q is the first reliable and adapted instrument in an Arab country for the evaluation of QoL in patients with CD. CD negatively influences this QoL, especially items related to gluten-free products.
Collapse
Affiliation(s)
- Morad Guennouni
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco.
| | - Brahim Admou
- Cadi Ayyad University, Biosciences Research Laboratory, Faculty of Medicine and Pharmacy, Laboratory of Immunology, Center of Clinical Research, University Hospital Mohamed VI, Marrakech, Morocco
| | - Noureddine Elkhoudri
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Sara Bouchrit
- Cadi Ayyad University, Faculty of Medicine and Pharmacy of Marrakech, Gastroenterology and Diet department, Marrakech, Morocco
| | - Adil Ait Rami
- Cadi Ayyad University, Faculty of Medicine and Pharmacy of Marrakech, Gastroenterology and Diet department, Marrakech, Morocco
| | - Aicha Bourrahouat
- Cadi Ayyad University, Faculty of Medicine and Pharmacy of Marrakech, Gastroenterology and Diet department, Marrakech, Morocco
| | - Khadija Krati
- Cadi Ayyad University, Faculty of Medicine and Pharmacy of Marrakech, Gastroenterology and Diet department, Marrakech, Morocco
| | - Abderraouf Hilali
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco
| |
Collapse
|
14
|
Elwenspoek MM, Thom H, Sheppard AL, Keeney E, O'Donnell R, Jackson J, Roadevin C, Dawson S, Lane D, Stubbs J, Everitt H, Watson JC, Hay AD, Gillett P, Robins G, Jones HE, Mallett S, Whiting PF. Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling. Health Technol Assess 2022; 26:1-310. [PMID: 36321689 PMCID: PMC9638887 DOI: 10.3310/zuce8371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Coeliac disease is an autoimmune disorder triggered by ingesting gluten. It affects approximately 1% of the UK population, but only one in three people is thought to have a diagnosis. Untreated coeliac disease may lead to malnutrition, anaemia, osteoporosis and lymphoma. OBJECTIVES The objectives were to define at-risk groups and determine the cost-effectiveness of active case-finding strategies in primary care. DESIGN (1) Systematic review of the accuracy of potential diagnostic indicators for coeliac disease. (2) Routine data analysis to develop prediction models for identification of people who may benefit from testing for coeliac disease. (3) Systematic review of the accuracy of diagnostic tests for coeliac disease. (4) Systematic review of the accuracy of genetic tests for coeliac disease (literature search conducted in April 2021). (5) Online survey to identify diagnostic thresholds for testing, starting treatment and referral for biopsy. (6) Economic modelling to identify the cost-effectiveness of different active case-finding strategies, informed by the findings from previous objectives. DATA SOURCES For the first systematic review, the following databases were searched from 1997 to April 2021: MEDLINE® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), Cochrane Library, Web of Science™ (Clarivate™, Philadelphia, PA, USA), the World Health Organization International Clinical Trials Registry Platform ( WHO ICTRP ) and the National Institutes of Health Clinical Trials database. For the second systematic review, the following databases were searched from January 1990 to August 2020: MEDLINE, Embase, Cochrane Library, Web of Science, Kleijnen Systematic Reviews ( KSR ) Evidence, WHO ICTRP and the National Institutes of Health Clinical Trials database. For prediction model development, Clinical Practice Research Datalink GOLD, Clinical Practice Research Datalink Aurum and a subcohort of the Avon Longitudinal Study of Parents and Children were used; for estimates for the economic models, Clinical Practice Research Datalink Aurum was used. REVIEW METHODS For review 1, cohort and case-control studies reporting on a diagnostic indicator in a population with and a population without coeliac disease were eligible. For review 2, diagnostic cohort studies including patients presenting with coeliac disease symptoms who were tested with serological tests for coeliac disease and underwent a duodenal biopsy as reference standard were eligible. In both reviews, risk of bias was assessed using the quality assessment of diagnostic accuracy studies 2 tool. Bivariate random-effects meta-analyses were fitted, in which binomial likelihoods for the numbers of true positives and true negatives were assumed. RESULTS People with dermatitis herpetiformis, a family history of coeliac disease, migraine, anaemia, type 1 diabetes, osteoporosis or chronic liver disease are 1.5-2 times more likely than the general population to have coeliac disease; individual gastrointestinal symptoms were not useful for identifying coeliac disease. For children, women and men, prediction models included 24, 24 and 21 indicators of coeliac disease, respectively. The models showed good discrimination between patients with and patients without coeliac disease, but performed less well when externally validated. Serological tests were found to have good diagnostic accuracy for coeliac disease. Immunoglobulin A tissue transglutaminase had the highest sensitivity and endomysial antibody the highest specificity. There was little improvement when tests were used in combination. Survey respondents (n = 472) wanted to be 66% certain of the diagnosis from a blood test before starting a gluten-free diet if symptomatic, and 90% certain if asymptomatic. Cost-effectiveness analyses found that, among adults, and using serological testing alone, immunoglobulin A tissue transglutaminase was most cost-effective at a 1% pre-test probability (equivalent to population screening). Strategies using immunoglobulin A endomysial antibody plus human leucocyte antigen or human leucocyte antigen plus immunoglobulin A tissue transglutaminase with any pre-test probability had similar cost-effectiveness results, which were also similar to the cost-effectiveness results of immunoglobulin A tissue transglutaminase at a 1% pre-test probability. The most practical alternative for implementation within the NHS is likely to be a combination of human leucocyte antigen and immunoglobulin A tissue transglutaminase testing among those with a pre-test probability above 1.5%. Among children, the most cost-effective strategy was a 10% pre-test probability with human leucocyte antigen plus immunoglobulin A tissue transglutaminase, but there was uncertainty around the most cost-effective pre-test probability. There was substantial uncertainty in economic model results, which means that there would be great value in conducting further research. LIMITATIONS The interpretation of meta-analyses was limited by the substantial heterogeneity between the included studies, and most included studies were judged to be at high risk of bias. The main limitations of the prediction models were that we were restricted to diagnostic indicators that were recorded by general practitioners and that, because coeliac disease is underdiagnosed, it is also under-reported in health-care data. The cost-effectiveness model is a simplification of coeliac disease and modelled an average cohort rather than individuals. Evidence was weak on the probability of routine coeliac disease diagnosis, the accuracy of serological and genetic tests and the utility of a gluten-free diet. CONCLUSIONS Population screening with immunoglobulin A tissue transglutaminase (1% pre-test probability) and of immunoglobulin A endomysial antibody followed by human leucocyte antigen testing or human leucocyte antigen testing followed by immunoglobulin A tissue transglutaminase with any pre-test probability appear to have similar cost-effectiveness results. As decisions to implement population screening cannot be made based on our economic analysis alone, and given the practical challenges of identifying patients with higher pre-test probabilities, we recommend that human leucocyte antigen combined with immunoglobulin A tissue transglutaminase testing should be considered for adults with at least a 1.5% pre-test probability of coeliac disease, equivalent to having at least one predictor. A more targeted strategy of 10% pre-test probability is recommended for children (e.g. children with anaemia). FUTURE WORK Future work should consider whether or not population-based screening for coeliac disease could meet the UK National Screening Committee criteria and whether or not it necessitates a long-term randomised controlled trial of screening strategies. Large prospective cohort studies in which all participants receive accurate tests for coeliac disease are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42019115506 and CRD42020170766. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 44. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Martha Mc Elwenspoek
- National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Howard Thom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athena L Sheppard
- National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel O'Donnell
- National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joni Jackson
- National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cristina Roadevin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Hazel Everitt
- Primary Care Research Centre, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Jessica C Watson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, UK
| | - Gerry Robins
- Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Penny F Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
15
|
Micronutrient deficiencies are frequent in adult patients with and without celiac disease on a gluten-free diet, regardless of the duration and adherence to the diet. Nutrition 2022; 103-104:111809. [DOI: 10.1016/j.nut.2022.111809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/04/2022] [Accepted: 07/23/2022] [Indexed: 11/18/2022]
|
16
|
Moreno MDL, Sánchez-Muñoz D, Sousa C. Quality of Life in Teenagers and Adults With Coeliac Disease: From Newly Spanish Coeliac Disease Questionnaire Validation to Assessment in a Population-Based Study. Front Nutr 2022; 9:887573. [PMID: 35711551 PMCID: PMC9194896 DOI: 10.3389/fnut.2022.887573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoeliac disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten in genetically predisposed individuals. Gluten restriction in CD sufferers leads to numerous limitations in various aspects of daily life and can significantly impact the quality-of-life (QoL). The specific and widely used Coeliac Disease Questionnaire (CDQ) is an excellent tool to evaluate QoL in patients with CD, assessing physical, psychological, and social domains. This questionnaire is unavailable in Spain. Therefore, our study is the first to translate, culturally adapt, validate, and apply the Spanish version of CDQ to a representative sample of Spanish teenagers and adults with CD.MethodsA total of 153 CD participants with biopsy-proven and self-reported gluten-free adherence were included in the cross-sectional study, which included four stages: (1) translation and retranslation of the French CDQ version into Spanish; (2) cultural adaptation and semantic evaluation; (3) CDQ validation through the internal consistency determination and reproducibility of the QoL; and (4) application of the questionnaire to Spanish teenagers and adults with CD and estimation of QoL using EQ-5D.ResultsThe internal consistency and test–retest reliability of the Spanish CDQ were satisfactory and no ceiling or floor effects were detected. Significant correlations were identified between the CDQ scales, and the instrument for validation covering similar dimensions of the QoL was identified. The mean CDQ total score was 131.03 ± 24.1, and the social domain had the highest rating. There was no correlation between the time spent on a gluten-free diet and QoL. A significantly higher QoL score was reported among males and adolescents in the 15–17 age groups.ConclusionThe newly Spanish CDQ is an appropriate tool to assess the QoL of the teenager and adult patients with CD. This study highlights the importance of identifying the affected scales to address actions to reduce the impact of the gluten-free diet burden of the coeliac patients and maintain public health regulations that support patients with chronic diseases such as CD.
Collapse
Affiliation(s)
- María de Lourdes Moreno
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Seville, Spain
| | | | - Carolina Sousa
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Seville, Spain
- *Correspondence: Carolina Sousa,
| |
Collapse
|
17
|
Dowd AJ, Tang KTY, Chen MY, Jung ME, Mosewich A, Welstead L, Culos-Reed SN. Improvements in self-compassion after an online program for adults with celiac disease: Findings from the POWER-C study. SELF AND IDENTITY 2022. [DOI: 10.1080/15298868.2022.2074091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Justine Dowd
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karen T. Y. Tang
- Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Michelle Y. Chen
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary E. Jung
- School of Health and Exercise Sciences, University of British Columbia at Okanagan,Calgary, Alberta, Canada
| | - Amber Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Welstead
- Faculty of Medicine, University of Chicago, Chicago, United States
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Wessels M, Dolinsek J, Castillejo G, Donat E, Riznik P, Roca M, Valitutti F, Veenvliet A, Mearin ML. Follow-up practices for children and adolescents with celiac disease: results of an international survey. Eur J Pediatr 2022; 181:1213-1220. [PMID: 34817672 DOI: 10.1007/s00431-021-04318-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Adequate follow-up in celiac disease is important to improve dietary compliance and treat disease-related symptoms and possible complications. However, data on the follow-up of celiac children is scarce. We aimed to assess current pediatric celiac follow-up practices across Europe. Pediatricians and pediatric gastroenterologists from 35 countries in Europe, Israel, Turkey, and Russia completed an anonymous survey which comprised a 52-item questionnaire developed by the ESPGHAN Special Interest Group on Celiac Disease. A total of 911 physicians, the majority of whom exclusively worked in pediatric care (83%) and academic institutions (60%), completed the questionnaire. Mean age and mean experience with celiac care were 48.7 years (± 10.6) and 15.7 years (± 9.9), respectively. The vast majority (≥ 92%) always assessed anthropometry, dietary adherence, and tissue-transglutaminase IgA-antibodies at every visit, with the first visit being between 3 and 6 months after diagnosis. Other parameters (% always tested) were as follows: complete blood count (60%), iron status (48%), liver enzymes (42%), thyroid function (38%), and vitamin D (26%). Quality of life was never assessed by 35% of the responding physicians. Transition to adult care was mostly completed via a written transition report (37%) or no formal transition at all (27%).Conclusions: Follow-up of celiac children and adolescents in Europe may be improved, especially regarding a more rational use of (laboratory) tests, dietary and QoL assessment, and transition to adult care. Evidence-based advice from international scientific societies is needed. What is Known: • Follow-up in celiac disease is important to treat disease-related symptoms, improve dietary compliance, and prevent possible complications. • There is a lack of consensus about the appropriate follow-up. What is New: • Almost all European physicians assess anthropometry, tissue-transglutaminase IgA-antibodies, and dietary adherence at every visit, but there are large variations in other follow-up aspects. • Follow-up could be improved by a more rational use of (laboratory) tests, increased intention to dietary compliance, and quality of life together with transition programs to adult care.
Collapse
Affiliation(s)
- Margreet Wessels
- Department of Pediatrics, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
| | - Jernej Dolinsek
- Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia.,Department of Pediatrics, Medical Faculty, University Medical Centre Maribor, Maribor, Slovenia
| | - Gemma Castillejo
- Pediatric Gastroenterology Unit, Hospital Universitario Sant Joan de Reus, Reus, Spain
| | - Ester Donat
- Pediatric Gastroenterology and Hepatology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Petra Riznik
- Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia
| | - Maria Roca
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | | | - Anne Veenvliet
- Department of Pediatrics, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
19
|
Lebovits J, Lee AR, Ciaccio EJ, Wolf RL, Davies RH, Cerino C, Lebwohl B, Green PHR. Impact of Celiac Disease on Dating. Dig Dis Sci 2022; 67:5158-5167. [PMID: 35635630 PMCID: PMC9150385 DOI: 10.1007/s10620-022-07548-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/30/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIMS When seeking a romantic partner, individuals with celiac disease (CD) must navigate challenging social situations. We aimed to investigate dating-related behaviors in adults with CD. METHODS A total of 11,884 affiliates of the Celiac Disease Center at Columbia University were invited to participate in an online survey. Adults (≥ 18 years) with biopsy-diagnosed CD were included. Among the 5,249 who opened the email, 538 fully completed the survey (10.2%). The survey included a CD-specific dating attitudes/behaviors questionnaire, a Social Anxiety Questionnaire (SAQ), a CD-specific quality of life instrument (CD-QOL), and a CD Food Attitudes and Behaviors scale (CD-FAB). RESULTS Respondents were primarily female (86.8%) and the plurality (24.4%) was in the 23-35 year age range. 44.3% had dated with CD, and among them, 68.4% reported that CD had a major/moderate impact on their dating life. A major/moderate impact was more commonly reported among females (69.3%, p < 0.001), 23-35-year-olds (77.7%, p = 0.015), those with a household income < $50 K (81.7%, p = 0.019), and those with a lower CD-QOL score (50.5 vs. 73.4, p = 0.002). While on dates, 39.3% were uncomfortable explaining precautions to waiters, 28.2% engaged in riskier eating behaviors, and 7.5% intentionally consumed gluten. 39.0% of all participants were hesitant to kiss their partner because of CD; females more so than males (41.1% vs. 22.7%, p = 0.005). CONCLUSIONS The majority of participants felt that CD had a major/moderate impact on their dating life. This impact may result in hesitation toward dating and kissing, decreased QOL, greater social anxiety, and less adaptive eating attitudes and behaviors. CD and the need to adhere to a gluten free diet have a major impact on dating and intimacy.
Collapse
Affiliation(s)
- Jessica Lebovits
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Anne R. Lee
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Edward J. Ciaccio
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Randi L. Wolf
- grid.21729.3f0000000419368729Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Rebecca H. Davies
- grid.21729.3f0000000419368729Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Chloe Cerino
- grid.21729.3f0000000419368729Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Benjamin Lebwohl
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Peter H. R. Green
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| |
Collapse
|
20
|
Guennouni M, Admou B, Bourrhouate A, Elkhoudri N, Fguirouche A, Nibaruta JC, Hilali A. Quality of life of Moroccan children with celiac disease: Arabic translation and validation of a specific celiac disease instrument. J Pediatr Nurs 2022; 62:e1-e7. [PMID: 35125172 DOI: 10.1016/j.pedn.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Gluten-free diet (GFD) is a lonely lifelong management for patients with celiac disease (CD), which may affect their quality of life (QoL). This can be evaluated by generic or specific instruments. We aimed to translate, validate and cross-culturally adapt a specific-CD instrument to Moroccan-Arabic version (M-CD-DUX), and then apply it to evaluate the QoL of Moroccan celiac children. DESIGN AND METHODS CD-DUX instrument was translated and culturally adapted, and preliminarily evaluated on 15 children and their proxies. The reproducibility and internal consistency of M-CD-DUX were measured by intra-class coefficient (ICC) and Cronbach α tests respectively. The statistical analysis of data consisted was conducted using SPSS, and the Goodness-of-Fit test was measured by SPSS AMOS. RESULTS The reliability of M-CD-DUX instrument showed a good internal consistency and reproducibility. The psychometric properties of M-CD-DUX were acceptable, and the instrument's Model fit was good [(Root Mean Square Error of Approximation = 0.062; χ2 = 603.08, p < 0.001]. M-CD-DUX was completed by 52 celiac children and their proxies. It showed a worse QoL for all items and subscales, and no difference was observed between the QoL of celiac children already under GFD and those recently diagnosed. CONCLUSION M-CD-DUX was the first reliable and adapted instrument used to evaluate the QoL of celiac children in an Arab country, emphasizing a negative impact of CD on their QoL. PRACTICE IMPLICATIONS Therefore, improving their QoL requires to make gluten-free products available to them at an appropriate price as well as a good integration into society.
Collapse
Affiliation(s)
- Morad Guennouni
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco.
| | - Brahim Admou
- Cadi Ayyad University, B2S Research Laboratory, Faculty of Medicine and Pharmacy, Laboratory of Immunology, Center of Clinical Research, University Hospital Mohamed VI, Marrakech, Morocco
| | - Aicha Bourrhouate
- Cadi Ayyad University, Faculty of Medicine and Pharmacy of Marrakech, Padiatric Gastro-enterology and Diet Unit, Marrakesh, Morocco
| | - Noureddine Elkhoudri
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco.
| | - Abir Fguirouche
- Cadi Ayyad University, B2S Research Laboratory, Faculty of Medicine and Pharmacy, Laboratory of Immunology, Center of Clinical Research, University Hospital Mohamed VI, Marrakech, Morocco
| | - Jean Claude Nibaruta
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Abderraouaf Hilali
- Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Laboratory of Health Sciences and Technologies, Settat, Morocco.
| |
Collapse
|
21
|
Lee AR, Lebwohl B, Lebovits J, Wolf RL, Ciaccio EJ, Green PHR. Factors Associated with Maladaptive Eating Behaviors, Social Anxiety, and Quality of Life in Adults with Celiac Disease. Nutrients 2021; 13:4494. [PMID: 34960046 PMCID: PMC8708489 DOI: 10.3390/nu13124494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 01/05/2023] Open
Abstract
A gluten-free diet (GFD), which is the only treatment for celiac disease (CeD), is challenging and associated with higher levels of anxiety, disordered eating, and lower quality of life (QOL). We examined various demographic and health factors associated with social anxiety, eating attitudes and behaviors, and QOL. Demographics and health characteristics, QOL, eating attitudes and behaviors, and social anxiety of adults with CeD were acquired using validated measures. The mean scores for QOL, SAQ, and CDFAB were compared across various demographic groups using the Z statistical test. The mean QOL score was 57.8, which is in the moderate range. The social anxiety mean scores were high: 78.82, with 9% meeting the clinical cutoff for social anxiety disorder. Those on a GFD for a short duration had significantly higher SAQ scores (worse anxiety), higher CDFAB scores (worse eating attitudes and behavior), and lower QOL scores. Those aged 23-35 years had lower QOL scores (p < 0.003) and higher SAQ scores (p < 0.003). Being single (p < 0.001) and female (p = 0.026) were associated with higher SAQ scores. These findings suggest that the development of targeted interventions to maximize QOL and healthy eating behaviors as well as to minimize anxiety is imperative for some adults with CeD.
Collapse
Affiliation(s)
- Anne R. Lee
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Benjamin Lebwohl
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Jessica Lebovits
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Randi L. Wolf
- Teachers College, Columbia University, New York, NY 10027, USA;
| | - Edward J. Ciaccio
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Peter H. R. Green
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| |
Collapse
|
22
|
Systematic review: Exploration of the impact of psychosocial factors on quality of life in adults living with coeliac disease. J Psychosom Res 2021; 147:110537. [PMID: 34139581 DOI: 10.1016/j.jpsychores.2021.110537] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Individuals living with coeliac disease generally experience a remission of symptoms after adopting the gluten-free diet but often report substantial treatment burden and ongoing quality of life issues. Psychosocial factors have been suggested to play a significant role in post-diagnosis quality of life but have yet to be systematically reviewed. AIM To review the evidence for psychosocial factors associated with quality of life in adult coeliac disease cohorts. METHODS Studies were identified via systematic searches of eight databases (MEDLINE, Embase, Emcare, PsycINFO, Ovid Nursing, CINAHL, Informit Health Collection, Cochrane Library) in May 2019. RESULTS Fourteen studies were included involving 3372 participants (80.2% female, mean age = 46.4 years). Symptoms of depression and anxiety were the most examined psychosocial factors across all studies. Quality of life was differentially associated with psychological distress, illness perceptions, coping, and attitudes/behaviours regarding food and the gluten-free diet. CONCLUSION Several psychosocial factors are associated with quality of life in adults living with coeliac disease. Current evidence suggests these factors are interrelated and may influence quality of life directly, via reduced psychological well-being, and indirectly, via reduced adherence to the gluten-free diet. Future research is needed to examine these processes concurrently, with the aim of elucidating the psychosocial mechanisms underlying post-diagnosis well-being and identifying potential targets for psychosocial intervention.
Collapse
|
23
|
Dowd AJ, Kronlund L, Warbeck C, Parmar C, Daun JT, Wytsma-Fisher K, Reimer RA, Millet G, Fung T, Culos-Reed SN. Effects of a 12-week HIIT + group mediated cognitive behavioural intervention on quality of life among inactive adults with coeliac disease: findings from the pilot MOVE-C study. Psychol Health 2021; 37:440-456. [PMID: 34038293 DOI: 10.1080/08870446.2021.1921774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of the pilot MOVE-C study was to examine the effects of a 12-week high-intensity interval training (HIIT) plus lifestyle education program on quality of life (QoL), behavioural and psychosocial outcomes among inactive adults with coeliac disease. DESIGN This study used a 3 (time: baseline, immediately post and three months post) × 2 (group: experimental versus waitlist control) mixed design. After completing baseline testing, 41 participants were randomised to one of two groups: HIIT + or waitlist control (WLC). The HIIT + intervention involved twice-weekly HIIT, during which participants progressed to 14 × 30 s intervals (90% heart rate max; HRmax), with 2-minute recovery (50% HRmax). The HIIT + intervention also included six bi-weekly education sessions. RESULTS Participants in HIIT + reported significant improvements in QoL and exercise behaviour immediately post-intervention, and this was sustained three months post-intervention, whereas no changes in QoL nor exercise behaviour were reported in WLC. Improvements were also reported among HIIT + immediately after the intervention for gastrointestinal symptoms and self-compassion. All participants reported significant improvements in adherence to a GFD immediately post-intervention. CONCLUSION Findings from this pilot study provide preliminary evidence that a tailored exercise and lifestyle intervention can lead to improved QoL, exercise behaviour, gastrointestinal symptoms and self-compassion among inactive adults with coeliac disease.
Collapse
Affiliation(s)
- A Justine Dowd
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Liam Kronlund
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cassandra Warbeck
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Guillaume Millet
- Laboratory of Human Movement Biology, University Lyon, UJM-Saint-Etienne, Inter-University, Saint-Etienne, France
| | - Tak Fung
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
24
|
Zhang Q, Wolf RL, Lee AR, Catassi C, Zybert P, Green PH, Lebwohl B. Navigating celiac disease and the gluten-free diet in China. Nutr Health 2021; 27:395-403. [PMID: 33843325 DOI: 10.1177/0260106021990254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about celiac disease (CeD) diagnosis and management in China. AIM This pilot aimed to be the first study to describe, quantitatively and qualitatively, how individuals living in China navigate CeD and the gluten-free diet (GFD). METHODS Participants were 13 adults and four parents of children with reported CeD, recruited from 11 mainland China cities via an online GFD support group. CeD-specific quality of life (CD-QOL and CD-PQOL) and diet adherence (CDAT) were assessed. In-depth interviews addressed experiences with CeD and the GFD. RESULTS Six of 17 participants reported biopsy- or serology-confirmed CeD. The mean (SD) adult CDAT score was 15.2 (3.6), > 13 indicating inadequate GFD adherence. The mean adult CD-QOL score was 62.1 (24.1) out of 100, in the "medium" to "good" range. Results were similar in children. Major interview themes included: (1) a challenging journey to obtain diagnosis; (2) social and structural barriers to maintaining the GFD; and (3) reliance on self in management of CeD. CONCLUSION Obtaining a diagnosis, maintaining a GFD, and living with CeD can be extremely challenging in mainland China. Results suggest an urgent need for CeD-specific education and Asian-adapted GFD guidance for both healthcare practitioners and patients.
Collapse
Affiliation(s)
- Qianhui Zhang
- Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, USA
| | - Randi L Wolf
- Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, USA
| | - Anne R Lee
- Celiac Disease Center, 21611Columbia University Irving Medical Center, USA
| | - Carlo Catassi
- Department of Pediatrics, 9294Polytechnic University of Marche, Italy
| | - Patricia Zybert
- Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, USA
| | - Peter Hr Green
- Celiac Disease Center, 21611Columbia University Irving Medical Center, USA
| | - Benjamin Lebwohl
- Celiac Disease Center, 21611Columbia University Irving Medical Center, USA.,Mailman School of Public Health, Columbia University, USA
| |
Collapse
|
25
|
Nikniaz Z, Asghari Jafarabadi M, Ghaffarifar S, Ravand Z, Akbari Namvar Z, Shirmohammadi M. The Persian Translation and validation of the celiac disease quality of life questionnaire (CDQOL). Health Qual Life Outcomes 2021; 19:52. [PMID: 33568144 PMCID: PMC7876810 DOI: 10.1186/s12955-021-01694-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Considering the importance of having a celiac disease-specific measure of the quality of life (QOL) in Persian, the present study aimed to translate the celiac disease quality of life questionnaire (CDQOL) into Persian and evaluate its psychometric properties. METHODS In this cross-sectional study, the Forward-Backward translation method was used. The content validation ratio (CVR) and the content validity index (CVI) were used for content validity assessment. The construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on 220 celiac patients who were selected randomly from the celiac disease (CD) registry database. The correlations between the result of the Persian version of CDQOL (PCDQOL), self-rated QOL, and short form-36 (SF36) were analyzed using the Pearson correlation test. The internal consistency and test-retest reliability were measured through Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS In the present study, 220 celiac patients with a mean age of 35.54 ± 10.29 years participated. The mean CVI, CVR, and impact score of PCDQOL were 0.98, 0.96, and 4.82 respectively. Using EFA, four factors have extracted that had a good fit in CFA (Chi-square/DF = 1.74, RMSEA: 0.08, and CFI: 0.90, and NFI: 0.90). The results showed that there was a moderate to high correlation between PCDQOL, SF36 (r: 0.587, p = 0.02), and self-rated QOL (r: 0.64, p < 0.001). The questionnaire had high internal consistency (Cronbach alpha: 0.93) and test-retest reliability (ICC: 0.96 [0.86-0.99]). CONCLUSION The PCDQOL questionnaire could be used by physicians and nutritionists to assess HRQOL in celiac patients in Iran.
Collapse
Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeedeh Ghaffarifar
- Medical Education Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Ravand
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Akbari Namvar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Shirmohammadi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
26
|
Krenz U, Timmermann D, Gorbunova A, Lendt M, Schmidt S, von Steinbuechel N. Health-related quality of life after pediatric traumatic brain injury: A qualitative comparison between children's and parents' perspectives. PLoS One 2021; 16:e0246514. [PMID: 33566806 PMCID: PMC7875394 DOI: 10.1371/journal.pone.0246514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/20/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pediatric traumatic brain injury (TBI) may cause a wide range of symptoms, which can negatively affect the quality of life of patients and their entire families. No internationally and simultaneously developed disease-specific instrument exists for assessing pediatric health-related quality of life (HRQoL) after TBI. The aim of the current project is to provide original material from small group interviews with individuals after TBI concerning what they state is relevant for their HRQoL. This material is required for a further study to generate items for age-adapted questionnaires assessing the TBI-specific HRQoL of children and adolescents (C&A): the QOLIBRI-Kiddy/Kid/Ado and proxy versions (Quality of Life after Brain Injury-Kiddy/Kids/Adolescents/Proxy) for individuals aged 6-17 and their parents. METHODS The semi-structured interviews were conducted with separate small groups of C&A (n = 19), divided into three age groups (5-7y, 8-12y, 13-17y), after mild, moderate, and severe TBI, and with groups of the corresponding parents (n = 26). All interviews lasted for about 60 minutes, were recorded and transcribed verbatim. The statements were investigated by qualitative analyses and sorted into categories relevant to the HRQoL of C&A after TBI. Only descriptive group comparisons but no pairwise comparisons between children and corresponding parents were performed. RESULTS The analyses led to 32 subcategories, which were assigned to six main theoretically based HRQoL categories. Many agreements exist between the C&A's and parents' perspectives within the main categories, however their focus on HRQoL differs, especially concerning age-related contents. Parents of the youngest participant group already focus on topics such as autonomy, whereas this only becomes relevant for C&A from the age of eight years on. Interestingly, even 5-year-old children were able to discuss their HRQoL, which indicates the importance of a self-report instrument. CONCLUSIONS Results obtained from this qualitative study identify the content of the HRQoL dimensions important for C&A after TBI and their parents. Both, differences and similarities in the children's and the parents' views were investigated, to get a first insight in valid dimensions for the prospective questionnaires to be developed. In a future study, items for the questionnaires will be deducted from the small group interview material and psychometrically tested in C&A after TBI from Germany. This study will address whether all statements were assigned to the suitable dimensions and whether differences between C&A and parents persist.
Collapse
Affiliation(s)
- Ugne Krenz
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| | - Dagmar Timmermann
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| | - Anastasia Gorbunova
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Meerbusch, Germany
| | - Silke Schmidt
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Nicole von Steinbuechel
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| |
Collapse
|
27
|
Iorfida D, Valitutti F, Vestri A, Di Rocco A, Cucchiara S, Lubrano R, Montuori M. Dietary Compliance and Quality of Life in Celiac Disease: A Long-Term Follow-Up of Primary School Screening-Detected Patients. Front Pediatr 2021; 9:787938. [PMID: 34993165 PMCID: PMC8724911 DOI: 10.3389/fped.2021.787938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Whether the diagnostic approach for celiac disease (CD) can really affect quality of life (QoL) and dietary compliance remains controversial. Aims: This study aimed to evaluate QoL and compliance to gluten-free diet (GFD) in adolescents/young adults diagnosed with CD through a screening strategy during childhood compared to age-matched CD patients diagnosed by case-finding and to assess whether follow-up at a referral center for CD influences compliance and QoL. Materials and Methods: Thirty-seven CD patients who were diagnosed by screening programs (SC-group) and 38 age-matched CD patients diagnosed due to symptoms (CF-group) were enrolled. Patients were asked to answer a questionnaire on QoL, dietary compliance, and follow-up care for CD. Results: Twenty-nine patients of the SC-group (median age 18.0 years, interquartile range [IQR] 16.0-19.0) and 31 patients of the CF-group (median age 17.0 years, IQR 15.5-18.0) completed the questionnaire. No significant difference relating adherence to the GFD and QoL was shown between the two groups. The majority (93.5%) of CF-group regularly had annual follow-up at a referral center compared to 37.9% of the SC-group (p < 0.001). Conclusion: The diagnostic strategy does not seem to impact QoL and dietary compliance. However, implementation of follow-up might still be necessary for patients identified through screening.
Collapse
Affiliation(s)
- Donatella Iorfida
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy
| | - Francesco Valitutti
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy.,EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
| | - Arianna Di Rocco
- Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
| | - Salvatore Cucchiara
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy
| | - Riccardo Lubrano
- Pediatrics and Neonatology Unit, Department of Maternal and Child Health, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Monica Montuori
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy
| |
Collapse
|
28
|
Impact of Corona Virus Disease 2019 pandemic on adherence to gluten-free diet in Indian patients with celiac disease. Indian J Gastroenterol 2021; 40:613-620. [PMID: 34877633 PMCID: PMC8651155 DOI: 10.1007/s12664-021-01213-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/16/2021] [Indexed: 02/04/2023]
Abstract
AIMS Lockdown and restricted mobility due to the pandemic of corona virus disease 2019 (COVID-19) has severely affected the continuity of healthcare of patients with acute and chronic diseases. We evaluated the impact of COVID-19 on the adherence to gluten-free diet (GFD), symptom control, and quality of life (QOL) in patients with celiac disease (CeD). METHODS A questionnaire, consisting of both ad-hoc and validated questions, was created after review of literature, group discussions, and expert meetings. Standardized questionnaires namely CeD adherence test (CDAT), celiac symptom index score, and CeD-related QOL were used. The web-based questionnaire was sent to 3130 patients via social media and 452 responses (14.4%) were received. Also, additional 68 patients (not available on any social media application) were interviewed telephonically by a trained dietitian. RESULTS Overall, 505 patients (females: 318; mean age: 24.1±14.2 years) were included. While only 6.7% (n = 34) had poor compliance to GFD (CDAT > 17) before COVID-19 pandemic, it almost doubled to 12.6% (n = 64) during the COVID-19 pandemic times (p = 0.02). Furthermore, 4.9% (n = 25) of patients were diagnosed contacting COVID-19. Interestingly, 73.2% (n = 370) patients preferred online appointment than physical appointment. Most common difficulties faced during lockdown period were high delivery charges for getting gluten-free (GF) food at home (54.4%), increased prices of regular GF food (43.1%), and travelling long distance to arrange GF food (44.9%). CONCLUSIONS The COVID-19 pandemic has substantially affected the adherence, symptom control, and QOL in patients with CeD, attributable to unavailability, shortage of money, and heightened cost of GF food. The pandemic has offered an opportunity to practice teleconsultation approach for patients with CeD.
Collapse
|
29
|
Parada A, Méndez C, Espino A, Reyes Á, Santibáñez H. Adherence to a gluten-free diet and quality of life in Chilean celiac patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:429-431. [PMID: 33267589 DOI: 10.17235/reed.2020.7293/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION a gluten-free diet (GFD) is the treatment for celiac disease (CD), with adherence oscillating between 42 % and 91 %. The purpose of this study was to assess adherence to GFD and its relation to quality of life in Chilean celiac patients. METHODS three surveys were performed on-line: sociodemographic-health status, adherence to GFD and quality of life. RESULTS forty-eight per cent of respondents reported an excellent adherence to GFD and 49 % a good quality of life. CONCLUSIONS adherence to GFD is low among Chilean celiac patients.
Collapse
Affiliation(s)
- Alejandra Parada
- Nutrición, Diabetes y Metabolismo, Pontificia Universidad Católica de Chile, Chile
| | | | - Alberto Espino
- Gastroenterología, Pontificia Universidad Católica de Chile
| | - Álvaro Reyes
- Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello
| | | |
Collapse
|
30
|
Measurement of Inter-Individual Variability in Assessing the Quality of Life in Respondents with Celiac Disease. PSYCH 2020. [DOI: 10.3390/psych2040023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Quality of life of Celiac Disease (CD) patients is affected by constraints in their physical, social and emotional behaviour. Our objective is to assess differences in two relevant dimensions of the Celiac Quality of Life (CQoL) scale, Limitations due to the disease and Dysphoria (i.e., feelings of depression and discomfort), in relation to the perceived social support and some individual and disease-related characteristics. The paper exploits suitable unidimensional Item Response Theory (IRT) models to individually analyse the two mentioned dimensions of the CQoL and Multidimensional Latent Class IRT models for ordinal polytomous items in order to detect sub-populations of CD patients that are homogenous with respect to the perceived CQoL. The latter methods allow to address patients with similar characteristics to the same treatment, performing at the same time a more tailored overture to health promotion programmes. The analysis extracts the relevant patterns and relations among CD patients, disentangling respondents receiving CD diagnosis in adolescence or adult age rather than in childhood (the first perceive high levels of Limitations and Dysphoria), patients with high perceived social support, a factor influencing in a positive way motivation to engage in management of CD-related distress and psychological well-being, and participants who are married or cohabiting. The latter report higher latent trait levels.
Collapse
|
31
|
Turk E, Mičetić-Turk D, Šikić-Pogačar M, Tapajner A, Vlaisavljević V, Prevolnik Rupel V. Health related QoL in celiac disease patients in Slovenia. Health Qual Life Outcomes 2020; 18:356. [PMID: 33148252 PMCID: PMC7641854 DOI: 10.1186/s12955-020-01612-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/27/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Measurements of health-related quality of life (HRQoL) among celiac disease patients using a validated questionnaire have been lacking in Slovenia. This study aims to measure HRQoL in celiac disease (CD) patients using EQ-5D internationally validated questionnaire and comparing it to the HRQoL of the general population. METHODS In this cross sectional analysis all of the approximately 2000 members of the Slovenian Celiac Society were invited to take part. We used a 3 step approach for recruitment and data collection. HRQoL was evaluated through the EuroQoL EQ-5D-5L instrument (Slovenian version) and analysed using the ordinal logistic regression. RESULTS Out of 321 patients who gave their consent, 247 celiac patients were included in the study (77%). 68% of the participants were female and 53% of them lived in an urban setting. Most patients originated from North-East Slovenia, whereas approximately 30% of patients came from other Slovenian regions. The EQ-5D respondents' self-reported health status at the time of the study show that most patients have slight or no problems when living with CD. The duration of the gluten-free diet, academic education and rare (< 1 × year) doctor visits affect EQ-5D in a positive way. On the other hand, higher age and chronic rheumatic disease were negatively associated with EQ-5D also when compared to the general population. CONCLUSION This is the first Slovenian study to measure the HRQoL of Slovenian CD patients, using an internationally validated questionnaire. The results of our study show that HRQoL is slightly impaired among Slovenian patients with CD. Clinical characteristics are better determinants of their HRQoL than socio-demographic factors. Greater awareness of the impact of CD on patients' HRQoL would improve the holistic management of CD patients.
Collapse
Affiliation(s)
- Eva Turk
- Science Centre Health and Technology, University of South-Eastern Norway, Grønland 53, 3045, Drammen, Norway. .,Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia.
| | - Dušanka Mičetić-Turk
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | - Maja Šikić-Pogačar
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | - Alojz Tapajner
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | | | | |
Collapse
|
32
|
Koskimaa S, Kivelä L, Arvola T, Hiltunen P, Huhtala H, Kaukinen K, Kurppa K. Clinical characteristics and long-term health in celiac disease patients diagnosed in early childhood: Large cohort study. Dig Liver Dis 2020; 52:1315-1322. [PMID: 32900652 DOI: 10.1016/j.dld.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/12/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early detection of celiac disease could theoretically prevent most of the disease-associated complications, but long-term effects of this approach are unclear. AIMS To investigate features at diagnosis and adulthood health in celiac disease patients diagnosed in early childhood in 1965-2014. METHODS Medical data on 978 pediatric patients were collected and study questionnaires sent to 559 adult patients who were diagnosed in childhood. Results were compared between patients diagnosed in early (≤3.0 years) and later (3.1-17.9 years) childhood. RESULTS Early diagnosed patients (n=131) had more often total villous atrophy (37% vs 25%, p=0.001), gastrointestinal presentation (61% vs 47%, p<0.001), growth disturbances (70% vs 32%, p=0.001) and severe symptoms (30% vs 9%, p<0.001) and were less often screen-detected (10% vs 27%, p<0.001) at diagnosis than those diagnosed later (n=847). Among 239 adult responders, early diagnosed patients (n=36) had fewer comorbidities (33% vs 53%, p=0.034) but considered their health less often good/excellent (69% vs 84%, p=0.029). The groups were comparable in current age, dietary adherence, symptoms and health-related quality of life. CONCLUSION Despite more severe initial presentation, the long-term health in early diagnosed patients was mostly comparable or even better to those diagnosed later in childhood. Poorer self-perceived health suggests a need for support during the transition to adulthood care.
Collapse
Affiliation(s)
- Sara Koskimaa
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Laura Kivelä
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland; University of Helsinki and Helsinki University Hospital, Children's Hospital, and Pediatric Research Center, Helsinki, Finland.
| | - Taina Arvola
- Department of Pediatrics, Hospital District of Kanta-Häme, Hämeenlinna, Finland
| | - Pauliina Hiltunen
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Katri Kaukinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; Celiac Disease Research Center, Tampere University, Tampere, Finland
| | - Kalle Kurppa
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland; The University Consortium of Seinäjoki, and Department of Pediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| |
Collapse
|
33
|
Siniscalchi M, Zingone F, Savarino EV, D'Odorico A, Ciacci C. COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine. Dig Liver Dis 2020; 52:1071-1075. [PMID: 32425731 PMCID: PMC7229921 DOI: 10.1016/j.dld.2020.05.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022]
Abstract
Background Coronavirus Disease 2019 (COVID-19) causes severe complications and deaths all over the world. COVID-19 also has indirect effects from the lockdown and the possible lack of food. We aimed to evaluate the perception of this in Celiac Disease (CeD) patients who require a lifelong gluten-free diet as a therapy. Methods We invited by e-mail CeD adult patients from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) to answer an ad hoc COVID-19 survey. Results We sent the web survey to 651 email addresses and we received 276 answers (42,4%). CeD patients did not feel more vulnerable because they had CeD (not at all 56.6%) and they did not worry much about the possible shortness of gluten-free food during the epidemic (not at all 48.5%). The most worried were the elderly patients, patients with other comorbidities and females. Finally, CeD patients were happy with remote consultations and explicitly asked to have them. Discussion The COVID-19 pandemic has impacted a proportion of patients with CeD; in particular, women, elderly patients, patients with other comorbidities. COVID-19, although a challenging experience from the medical and the psychological point of view, has offered an opportunity to practice, on a large-scale, a remote consultation approach for CeD healthcare.
Collapse
Affiliation(s)
- Monica Siniscalchi
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Anna D'Odorico
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carolina Ciacci
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, Italy.
| |
Collapse
|
34
|
Assessment of quality of life in children, adolescents, and adults with celiac disease through specific questionnaires: Review. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
35
|
Lucendo AJ, Molina-Infante J. Dietary therapy for eosinophilic esophagitis: chances and limitations in the clinical practice. Expert Rev Gastroenterol Hepatol 2020; 14:941-952. [PMID: 32614693 DOI: 10.1080/17474124.2020.1791084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Eosinophilic esophagitis (EoE) is a non-Immunoglobulin E-mediated food allergy that currently represents the main cause of dysphagia and food impaction in children and young adults. Diet remains the only therapy targeting the cause of the disease. Relevant advances in recent years allow novel approaches to dietary therapy in EoE. AREAS COVERED An up-to-date review on dietary therapy for EoE is provided, as a potential first-line anti-inflammatory therapy able to induce and maintain remission in a significant proportion of patients. Unpractical elemental diets and suboptimal food allergy testing-directed food restrictions paved the way for empiric elimination diets, which currently are to be considered as the most effective drug-free treatment for EoE. After largely restrictive empiric six-food elimination diets, most efficient step-up approaches now include four-food and two-food elimination diets. The potential of milk-elimination is also discussed. EXPERT COMMENTARY An empiric elimination diet step-up strategy should be currently considered as the initial approach for dietary treatment in EoE patients of all ages. Compared to a top-down strategy, step-up diets reduce the need for endoscopic procedures, shorten diagnostic process times, and avoid unnecessary restrictions. Furthermore, early identification of responders with few food triggers may select best candidates for maintenance dietary therapy.
Collapse
Affiliation(s)
- Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso , Tomelloso, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) , Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa , Madrid, Spain
| | - Javier Molina-Infante
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) , Madrid, Spain.,Department of Gastroenterology, Hospital Universitario de Caceres , Caceres, Spain
| |
Collapse
|
36
|
Marsilio I, Canova C, D’Odorico A, Ghisa M, Zingone L, Lorenzon G, Savarino EV, Zingone F. Quality-of-Life Evaluation in Coeliac Patients on a Gluten-Free Diet. Nutrients 2020; 12:nu12102981. [PMID: 33003417 PMCID: PMC7601879 DOI: 10.3390/nu12102981] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
The treatment for coeliac disease (CD) has a considerable psychological impact on patients, which may vary depending on subjects and clinical characteristics. The aim of this study was to describe the quality of life (QoL) in CD patients during follow-up, evaluating which factors can influence it. Patients with CD who consecutively visited the outpatient clinic of CD Unit of the University Hospital of Padua from January to September 2019 were enrolled. Demographics and clinical information were collected, and all patients were asked to answer the CD-QoL and Biagi’s validated questionnaires. Student’s t-test and chi-square test were used to compare the continuous and categorical variables, respectively. One hundred patients were enrolled (86 females, mean age at test ± SD: 39.73 ± 13.51; mean age at diagnosis ± SD: 33.09 ± 12.92), with 61% of them having been diagnosed with CD within the previous 5 years. At the time of diagnosis, 43 CD patients reported classical CD presentation, 32 non-classical features, 16 only anaemia and 9 were asymptomatic. The mean CD-QoL value was overall high (80.54 ± 11.91). We found that the “health concerns” subscale score was significantly lower in subjects aged more than 35 years compared to younger subjects (p = 0.03). We also observed that the CD-QoL score in gluten-free diet (GFD)-adherent patients tended to be higher compared to subjects who were non-compliant, with a significantly higher percentage of patients with low score for the “dysphoria” subscale (p = 0.05). This study showed an overall good QoL in subjects on a GFD. However, subjects older and non-compliant to GFD appear to experience more health concerns and suffer from dysphoria, respectively.
Collapse
Affiliation(s)
- Ilaria Marsilio
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Cristina Canova
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University Hospital of Padua, 35128 Padua, Italy;
| | - Anna D’Odorico
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Matteo Ghisa
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | | | - Greta Lorenzon
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
- Correspondence:
| |
Collapse
|
37
|
Dowd AJ, Warbeck CB, Tang KT, Fung T, Culos-Reed SN. MyHealthyGut: Findings from a pilot randomized controlled trial on adherence to a gluten-free diet and quality of life among adults with celiac disease or gluten intolerance. Digit Health 2020; 6:2055207620903627. [PMID: 32071731 PMCID: PMC6997956 DOI: 10.1177/2055207620903627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/26/2019] [Indexed: 01/11/2023] Open
Abstract
Aims The purpose of this study was to assess the effectiveness of a smartphone app
(MyHealthyGut) in helping adults self-manage celiac disease or gluten
intolerance and improve their gut health. Methods Adults diagnosed with celiac disease or gluten intolerance
(N = 115) were randomized into two groups: experimental
group 1 (had access to the app for a one-month period) or wait list control
(WLC). After one month, WLC participants were given one-month access to the
app (experimental group 2). An online questionnaire was administered to
assess (a) user satisfaction with the app and (b) changes in the following
patient-reported outcomes: adherence to a gluten-free diet, quality of life
(QoL), self-regulatory efficacy, and feelings of depression and anxiety.
Generalized estimating equations were used to assess changes in the outcome
variables over time between the groups. Results Participants reported high levels of app usability, were satisfied with
features of the app, and felt that the app was best suited for people newly
diagnosed with celiac disease. Participants in the experimental groups
reported improvements in adherence, gastrointestinal symptoms (experimental
group 1 only), QoL, self-regulatory efficacy (experimental group 2 only),
anxiety (experimental group 1 only), and depression (experimental group 2
only). Experimental group 1 and the WLC group reported significantly worse
adherence after using the app based on the Celiac Dietary Adherence Test,
which was in contrast to the accidental and purposeful measures of gluten
consumption and symptoms for experimental group 1 but consistent with
reports of accidental and purposeful gluten consumption and symptoms for the
WLC group. Conclusions Based on feedback from the participants, the app may be best suited for
individuals newly diagnosed or struggling with celiac disease or gluten
intolerance. After using the MyHealthyGut app for a one-month period, adults
with celiac disease reported improvements in psychosocial outcomes. Further
iterations of the app are needed to meet the needs of this population
better. MyHealthyGut is the first evidence-based app designed to help people
with celiac disease or gluten intolerance.
Collapse
Affiliation(s)
| | | | | | - Tak Fung
- Research Computing Services, Information Technologies, University of Calgary, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
| |
Collapse
|
38
|
Kipp TO, Husby S, Skjerning H. The large majority of coeliacs have a high degree of perceived dietary competence. Scand J Gastroenterol 2019; 54:1452-1457. [PMID: 31738623 DOI: 10.1080/00365521.2019.1690039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: The treatment for coeliac disease (CD) is a gluten-free diet (GFD), which impacts the health-related quality of life (HRQoL). The aim of the study was to develop the Gluten-Free Diet Perceived Competence Scale (GFD-PCS): a short and precise CD-specific patient-reported outcome measure.Methods: The GFD-PCS was developed from the scales 'Perceived Competence (Maintaining a Healthy Diet)' and 'Perceived Competence for Diabetes'. The scale was then programmed into a web-based questionnaire and distributed together with generic quality of life (WHO-5) and CD-specific HRQoL (CDQL) questionnaires.Results: There were 931 respondents. The 831 who reported 'diagnosed CD' were retained. The average age was 37.6 years (SD = 16.5). There was no statistically significant difference between males (M = 5.9, SD = 1.6) and females (M = 6.2, SD = 1.4) in GFD-PCS score. Respondents younger than 18 years (n = 104) scored lower (M = 5.8, SD = 1.4) than adults (M = 6.2, SD = 1.4). The psychometric properties of the GFD-PCS showed excellent internal reliability (α = .96) and satisfied construct and criterion validity.Conclusion: The GFD-PCS measures patient-perceived dietary competence for maintaining a GFD. The scale is psychometrically robust and provides a useful tool in assessing patients' difficulties with a GFD.
Collapse
Affiliation(s)
- Thomas O Kipp
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Halfdan Skjerning
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
39
|
Fueyo-Díaz R, Magallón-Botaya R, Gascón-Santos S, Asensio-Martínez Á, Palacios-Navarro G, Sebastián-Domingo JJ. The effect of self-efficacy expectations in the adherence to a gluten free diet in celiac disease. Psychol Health 2019; 35:734-749. [PMID: 31608661 DOI: 10.1080/08870446.2019.1675658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: To analyse the effect of general and specific self-efficacy on the adherence to a gluten free diet (GFD) in patients with celiac disease along with the effect of other relevant variables.Design: 271 patients with celiac disease participated in this transversal descriptive study and completed a series of questionnaires regarding adherence (CDAT), general self-efficacy (GSES) and specific self-efficacy (Celiac-SE) and quality of life (CD-Qol), among others.Main Outcome Measures: Dependent variable was adherence to the Gluten Free Diet (GFD). Main independent variables were general self-efficacy, specific self-efficacy and quality of life. Model tests were conducted using regression analysis.Results: 71.9% of patients show an excellent or good adherence to the diet. Higher levels of adherence are positively associated to a high expectancy of specific self-efficacy, to the perceived adoption of recommended behaviours, risk perception and better quality of life (these variables accounted for 36.4% of the variance in the adherence to a GFD, p < .001).Conclusions: Specific self-efficacy rather than general has a predictive value in adherence to a GFD. Therefore, we need to develop and transculturally adapt new instruments to assess specific self-efficacy. Celiac-SE has proved to be a useful scale for this objective.
Collapse
Affiliation(s)
- Ricardo Fueyo-Díaz
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,Aragon Institute of Health Sciences IACS, Zaragoza, Spain.,Aragon Health Research Institute IISA, Group B21-17R, Zaragoza, Spain.,RediAPP Primary Care Prevention and Promotion Network RD16/07/05, Institute of Health Carlos III, Spain
| | - Rosa Magallón-Botaya
- Aragon Health Research Institute IISA, Group B21-17R, Zaragoza, Spain.,RediAPP Primary Care Prevention and Promotion Network RD16/07/05, Institute of Health Carlos III, Spain.,Department of Medicine, University of Zaragoza, Spain
| | - Santiago Gascón-Santos
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,Aragon Institute of Health Sciences IACS, Zaragoza, Spain
| | - Ángela Asensio-Martínez
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,Aragon Institute of Health Sciences IACS, Zaragoza, Spain.,Aragon Health Research Institute IISA, Group B21-17R, Zaragoza, Spain.,RediAPP Primary Care Prevention and Promotion Network RD16/07/05, Institute of Health Carlos III, Spain
| | | | - Juan J Sebastián-Domingo
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain.,Department of Medicine, University of Zaragoza, Spain.,Department of Digestive Diseases, Hospital Royo Villanova, Zaragoza, Spain
| |
Collapse
|
40
|
How to best measure quality of life in coeliac disease? A validation and comparison of disease-specific and generic quality of life measures. Eur J Gastroenterol Hepatol 2019; 31:941-947. [PMID: 31045631 DOI: 10.1097/meg.0000000000001432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is an important outcome in chronic disease. Generic HRQoL questionnaires may not adequately reflect disease-specific challenges in coeliac disease. We investigated whether disease-specific HRQoL questionnaires add relevant information to generic measures that will better help to identify patients experiencing problems. PATIENTS AND METHODS We performed a cross-cultural validation of the Celiac Disease Quality Of Life-survey (CD-QOL), next we developed and validated a new disease-specific HRQoL questionnaire, and finally compared their predictive validity with the disease-generic RAND SF-36/SF-12 in 825 patients (mean age: 56.1±15.8 years) with (reported) biopsy-proven coeliac disease. Internal consistency and convergent, discriminative and predictive validity of the questionnaires was determined. RESULTS Two Dutch versions of the CD-QOL were validated, consisting of 14 and six items, respectively (CD-QOL-14-NL, CD-QOL-6-NL). We developed and validated the CeliacQ-27, which has 27-items across three subscales (Limitations, Worries and Impact on daily life), and a short seven-item version, the CeliacQ-7. All questionnaires had excellent psychometric properties and differentiated well between active disease and clinical remission and strict versus poor dietary adherence. The added value of the disease-specific questionnaires to the generic HRQoL measure to the explained variance of symptom burden and dietary adherence was limited. CONCLUSION HRQoL in patients with coeliac disease can easily be assessed by brief generic as well as disease-specific measures. Disease-specific questionnaires, however, provide more explicit information on disease-relevant areas of functioning.
Collapse
|
41
|
Dowd AJ, Kronlund L, Parmar C, Daun JT, Wytsma-Fisher K, Reimer RA, Millet GY, Culos-Reed SN. A 12-Week Pilot Exercise Program for Inactive Adults With Celiac Disease: Study Protocol. Glob Adv Health Med 2019; 8:2164956119853777. [PMID: 31218116 PMCID: PMC6563390 DOI: 10.1177/2164956119853777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/24/2019] [Accepted: 05/01/2019] [Indexed: 12/17/2022] Open
Abstract
Background Individuals with celiac disease must follow a strict gluten-free diet (GFD) in order to avoid negative short- and long-term health consequences. Unfortunately, many people with celiac disease report poor quality of life (QoL) despite following a strict GFD, and up to 30% still report negative symptoms (eg, gastrointestinal upset). Purpose The purpose of the MOVE-C (understanding the relationship between the MicrobiOme, Vitality, and Exercise in Celiac disease) pilot study is to explore the effects of a 12-week supervised progressive high-intensity interval training (HIIT) and lifestyle intervention on physiological, behavioral, and psychosocial outcomes among inactive adults with celiac disease. Methods/Design: Sixty inactive adults diagnosed with celiac disease will be randomized to HIIT+ or waitlist control (WLC). Participants in the HIIT+ will engage in a 12-week HIIT + lifestyle education program. HIIT sessions will be comprised of 2 workouts per week, working up to 14 × 30-second intervals at 90% maximal heart rate (HRmax) followed by 2 minutes recovery at 50% HRmax. The 6 biweekly lifestyle sessions will involve education on the promotion of a whole foods GFD, sleep hygiene, psychosocial coping skills (eg, self-compassion), and self-regulatory skills to master changes in behaviors. Assessments will occur at pre and post 12-week intervention and 3-month follow-up. WLC participants will be offered a 12-week HIIT program + online lifestyle education sessions after completing the final assessment. The primary outcomes are QoL and gut microbiota composition assessed with 16S rRNA sequencing. The secondary outcomes are markers of metabolic syndrome (waist circumference, fasting glucose, serum lipids, blood pressure, and body composition), gastrointestinal symptoms, sleep quality, adherence to a GFD, exercise behavior, self-regulatory efficacy, and self-compassion. It is hypothesized that participants in the HIIT+ will experience improvements in all outcomes when compared to those in the WLC. These improvements are expected to be maintained at the 3-month follow-up. Discussion The findings from this study will advance the knowledge regarding the effects of HIIT and lifestyle education on key outcomes for an at-risk chronic disease population. Furthermore, the findings can be used to inform future programs to improve fitness and physical and mental health outcomes for people with celiac disease.
Collapse
Affiliation(s)
- A Justine Dowd
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Liam Kronlund
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Candice Parmar
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Biochemistry & Molecular Biology, Cumming School of Medicine, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | | | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
42
|
Joelson AM, Geller MG, Zylberberg HM, Green PHR, Lebwohl B. Numbers and Features of Patients With a Diagnosis of Celiac Disease Without Duodenal Biopsy, Based on a National Survey. Clin Gastroenterol Hepatol 2019; 17:1089-1097.e2. [PMID: 30213582 DOI: 10.1016/j.cgh.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS According to guidelines, individuals with symptoms of celiac disease should undergo duodenal biopsy analysis to establish a diagnosis, but little is known about physician adherence to these guidelines. We used a patient-powered research network (PPRN) to compare demographics, diagnoses, symptoms, and treatment between groups of patients with celiac disease diagnosed by biopsy analysis and patients with a diagnosis based on results of serology tests. METHODS We analyzed data from iCureCeliac-a voluntary, PPRN hosted and distributed by the Celiac Disease Foundation, from January 30, 2016, through August 25, 2016. We compared data from adults with a diagnosis of celiac disease (mean age, 43.4 years; 85.6% female) based on biopsy analysis (n = 780) vs patients with a diagnosis based on only serologic analysis (n = 202) using univariate and multivariable analyses. We collected demographic information, as well as data on type of health care practitioner, where patients obtain their primary information about celiac disease, and the Celiac Disease Quality of Life score, nutritionist referral rates, adherence to the gluten-free diet, ongoing symptoms and use of supplements. RESULTS Among patients with a diagnosis based on serology results, 33.3% were diagnosed by non-gastroenterologists vs 20.7% in the biopsy diagnosed group (P < .001). Fewer patients with a diagnosis based on serology results sought nutritional counseling at the time of diagnosis (40.1%) than patients with a diagnosis based on biopsy (58.9%) (P < .001). A higher proportion of patients diagnosed by serology without biopsy took dietary supplements to aid in digestion of gluten (19.8%) than patients with a diagnosis based on biopsy (8.9%) (P < .001). After we adjusted for age and sex, patients with a diagnosis based on serology were less likely to seek nutritional counseling after diagnosis (odds ratio [OR], 0.45; 95% CI, 0.33-0.63), less likely to receive a diagnosis from a gastroenterologist (OR, 0.16; 95% CI, 0.07-0.37), and more likely to use digestive supplements (OR, 2.61; 95%, CI 1.62-4.19). CONCLUSIONS In an analysis of data from a PPRN, we found that 21% of adult participants with celiac disease did not have a diagnosis based on a duodenal biopsy. Patients with a diagnosis based on serology results were more likely to be diagnosed by non-gastroenterologists, less likely to seek nutritional counseling, and more likely to use dietary supplements. Patients require more education about management of celiac disease and referral to gastroenterologists for duodenal biopsy confirmation of their disease.
Collapse
Affiliation(s)
- Andrew M Joelson
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | | | - Haley M Zylberberg
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York; Deartment of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York.
| |
Collapse
|
43
|
Cadenhead JW, Wolf RL, Lebwohl B, Lee AR, Zybert P, Reilly NR, Schebendach J, Satherley R, Green PHR. 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. J Hum Nutr Diet 2019; 32:311-320. [PMID: 30834587 DOI: 10.1111/jhn.12638] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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.
Collapse
Affiliation(s)
- J W Cadenhead
- Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - R L Wolf
- Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - B Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA
| | - A R Lee
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA
| | - P Zybert
- Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - N R Reilly
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA
| | - J Schebendach
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - R Satherley
- Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, King's College London, London, UK
| | - P H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA
| |
Collapse
|
44
|
Singh P, Silvester JA, Leffler D. (Outcome) Measure for (Intervention) Measures: A Guide to Choosing the Appropriate Noninvasive Clinical Outcome Measure for Intervention Studies in Celiac Disease. Gastroenterol Clin North Am 2019; 48:85-99. [PMID: 30711213 PMCID: PMC6368393 DOI: 10.1016/j.gtc.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
There is an unmet need for diagnostic and treatment interventions for celiac disease. Both clinical trials and real-world studies require careful selection of clinical outcome measures. Often, neither serology nor histology is an appropriate primary outcome. This article reviews various measures of intestinal function and nutrition, patient-reported outcome measures for symptoms and for health-related quality of life, and measures of sickness burden as they apply to intervention studies for celiac disease. A series of case studies is presented to illustrate key considerations in selecting outcome measures for dietary interventions, pharmacologic interventions, and real-world studies.
Collapse
Affiliation(s)
- Prashant Singh
- Harvard Celiac Disease Research Program, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jocelyn A Silvester
- Harvard Celiac Disease Research Program, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02215, USA.
| | - Daniel Leffler
- Harvard Celiac Disease Research Program, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Gastroenterology Therapeutic Area Research and Development, Takeda Pharmaceuticals, 40 Landsdowne Street, Boston, MA 02139, USA
| |
Collapse
|
45
|
Abstract
Coeliac disease is an immune-mediated enteropathy against dietary gluten present in wheat, rye and barley and is one of the most common lifelong food-related disorders worldwide. Coeliac disease is also considered to be a systemic disorder characterized by a variable combination of gluten-related signs and symptoms and disease-specific antibodies in addition to enteropathy. The ingestion of gluten leads to the generation of harmful gluten peptides, which, in predisposed individuals, can induce adaptive and innate immune responses. The clinical presentation is extremely variable; patients may have severe gastrointestinal symptoms and malabsorption, extraintestinal symptoms or have no symptoms at all. Owing to the multifaceted clinical presentation, diagnosis remains a challenge and coeliac disease is heavily underdiagnosed. The diagnosis of coeliac disease is achieved by combining coeliac disease serology and small intestinal mucosal histology during a gluten-containing diet. Currently, the only effective treatment for coeliac disease is a lifelong strict gluten-free diet; however, the diet is restrictive and gluten is difficult to avoid. Optimizing diagnosis and care in coeliac disease requires continuous research and education of both patients and health-care professionals.
Collapse
|
46
|
Crocker H, Jenkinson C, Peters M. Quality of life in coeliac disease: item reduction, scale development and psychometric evaluation of the Coeliac Disease Assessment Questionnaire (CDAQ). Aliment Pharmacol Ther 2018; 48:852-862. [PMID: 30125953 PMCID: PMC6220785 DOI: 10.1111/apt.14942] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/27/2018] [Accepted: 07/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A better understanding of coeliac disease can be achieved by assessing health-related quality of life alongside clinical factors. Existing patient-reported outcome measures (PROMs) evaluating quality of life in coeliac disease have not been developed in accordance with the US Food and Drug Administration guidelines. AIM To develop a PROM in accordance with best practice guidelines, capturing all aspects of quality of life important to adults with coeliac disease. METHODS Candidate items for the Coeliac Disease Assessment Questionnaire (CDAQ) were refined through item appraisal, expert review, cognitive interviews, and a translatability assessment. A cross-sectional survey determined further item reduction and the CDAQ's structure. The final CDAQ was administered alongside the Short Form Health Survey Version 2 (SF?36v2) in a second survey to assess construct validity and test-retest reliability. RESULTS Pre-testing the 64 candidate items revealed a range of issues which guided their refinement and reduction, resulting in the final CDAQ with 32 items representing 5 subscales: stigma (eight items), dietary burden (eight items), symptoms (five items), social isolation (five items), and worries and concerns (six items). Cronbach's alpha ranged between 0.82 and 0.88 for all domains. Further results showed CDAQ scores were more strongly correlated with the SF-36v2's mental health dimensions, as expected. Intraclass correlation coefficients ranged from 0.79 to 0.89. CONCLUSION The CDAQ is a reliable and valid coeliac-specific measure that captures all aspects of quality of life important to adults with coeliac disease. Further work is underway to assess the CDAQ's responsiveness to change.
Collapse
Affiliation(s)
- Helen Crocker
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Crispin Jenkinson
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Michele Peters
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| |
Collapse
|
47
|
Development and Validation of the Coeliac Disease Food Attitudes and Behaviours Scale. Gastroenterol Res Pract 2018; 2018:6930269. [PMID: 30210536 PMCID: PMC6120326 DOI: 10.1155/2018/6930269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives Previous studies on coeliac disease suggest that attitudes towards the gluten-free diet may contribute to the development of disordered eating. This study describes the development and validation of the Coeliac Disease Food Attitudes and Behaviours scale (CD-FAB) to measure these behaviours in coeliac disease. Research Methods and Procedures Focus groups were used to develop 33 potential questionnaire items. These items were reviewed by service users and then distributed online to 157 adults with coeliac disease. Items were removed based on ceiling/floor effects, high interitem correlations (>0.7) and factor analysis. 11 items were retained. Exploratory factor analysis was then conducted. The psychometric properties of the final version of the CD-FAB were assessed via using an online platform. Results The CD-FAB had 11 items distributed across one factor assessing attitudes and behaviours towards food. These factors explained 44.1% of the variance in responding. The CD-FAB and its subscales had high internal consistency (Cronbach's alpha > 0.7) and psychometric validation indicated good convergent and discriminant validity. High scores on the CD-FAB are associated with psychological distress and an impaired quality of life. Conclusions The CD-FAB is a reliable and valid measure of food attitudes and behaviours in coeliac disease. As a new disease-specific instrument, it may be a useful tool for evaluating food concerns in individuals with coeliac disease in a clinical setting and for further exploring the development of disordered eating patterns in coeliac disease. Further research is required to assess the full potential of the CD-FAB.
Collapse
|
48
|
Ludvigsson JF, Ciacci C, Green PH, Kaukinen K, Korponay-Szabo IR, Kurppa K, Murray JA, Lundin KEA, Maki MJ, Popp A, Reilly NR, Rodriguez-Herrera A, Sanders DS, Schuppan D, Sleet S, Taavela J, Voorhees K, Walker MM, Leffler DA. Outcome measures in coeliac disease trials: the Tampere recommendations. Gut 2018; 67:1410-1424. [PMID: 29440464 PMCID: PMC6204961 DOI: 10.1136/gutjnl-2017-314853] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/19/2017] [Accepted: 01/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A gluten-free diet is the only treatment option of coeliac disease, but recently an increasing number of trials have begun to explore alternative treatment strategies. We aimed to review the literature on coeliac disease therapeutic trials and issue recommendations for outcome measures. DESIGN Based on a literature review of 10 062 references, we (17 researchers and 2 patient representatives from 10 countries) reviewed the use and suitability of both clinical and non-clinical outcome measures. We then made expert-based recommendations for use of these outcomes in coeliac disease trials and identified areas where research is needed. RESULTS We comment on the use of histology, serology, clinical outcome assessment (including patient-reported outcomes), quality of life and immunological tools including gluten immunogenic peptides for trials in coeliac disease. CONCLUSION Careful evaluation and reporting of outcome measures will increase transparency and comparability of coeliac disease therapeutic trials, and will benefit patients, healthcare and the pharmaceutical industry.
Collapse
Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Carolina Ciacci
- Coeliac Center at Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Peter Hr Green
- Celiac Disease Center at Columbia University, New York, USA
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilma R Korponay-Szabo
- Coeliac Disease Centre, Heim Pál Children's Hospital, Budapest, Hungary
- Department of Paediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kalle Kurppa
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | | | - Knut Erik Aslaksen Lundin
- Institute of Clinical Medicine and K.G. Jebsen Coeliac Disease Research Centre, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Markku J Maki
- Science Center, Tampere University Hospital, Tampere, Finland
- Tampere Centre for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Alina Popp
- Institute for Mother and Child Health Bucharest, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
- Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Norelle R Reilly
- Division of Pediatric Gastroenterology, Columbia University Medical Center, New York, USA
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, USA
| | | | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Detlef Schuppan
- Celiac Center, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Juha Taavela
- Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland
| | | | - Marjorie M Walker
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Daniel A Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
49
|
Crocker H, Jenkinson C, Peters M. Quality of life in coeliac disease: qualitative interviews to develop candidate items for the Coeliac Disease Assessment Questionnaire. PATIENT-RELATED OUTCOME MEASURES 2018; 9:211-220. [PMID: 30013408 PMCID: PMC6038864 DOI: 10.2147/prom.s149238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Coeliac-specific measures have been criticized for not complying with current guidance on the development of patient-reported outcome measures (PROMs). The aim of this study was to develop a measure to assess health-related quality of life in adults with coeliac disease (CD), in accordance with current guidance for PROM development. Methods In-depth qualitative interviews were conducted with adults with CD. A thematic analysis was undertaken to develop a coding framework. All interviews were analyzed according to this framework. Interviewing continued until data saturation was achieved. Candidate items were developed on the basis of the interview findings. Results The analysis revealed 6 themes: 1) symptoms, 2) gluten-free diet, 3) emotional health, 4) impact on activities, 5) relationships, and 6) financial issues. Data saturation was reached after 8 interviews, but a total of 23 interviews were conducted to include a wide enough range of diverse participants. From the themes, 64 candidate items (9 for symptoms, 15 for emotional health, 16 for gluten-free diet, 7 for relationships, 12 for impact on activities, and 5 for financial issues) were developed to form the first draft of the Coeliac Disease Assessment Questionnaire (CDAQ). Conclusion The 64 items reflect all the issues of importance to people with CD. Next, these items will be pretested and refined to lead to a shorter draft version of the CDAQ before it is administered in a survey to produce a final version with subscales.
Collapse
Affiliation(s)
- Helen Crocker
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| |
Collapse
|
50
|
Halmos EP, Deng M, Knowles SR, Sainsbury K, Mullan B, Tye-Din JA. Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease. Aliment Pharmacol Ther 2018; 48:78-86. [PMID: 29733115 DOI: 10.1111/apt.14791] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/17/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A gluten-free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level. AIM To comprehensively assess the patient factors that influence gluten-free diet adherence in patients with coeliac disease. METHODS Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life. RESULTS Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten-free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life (P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten-free foods, but could still recognise gluten-containing foods, suggesting that poor knowledge may lead to over-restriction of diet. CONCLUSIONS Poor knowledge of a gluten-free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten-free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.
Collapse
Affiliation(s)
- E P Halmos
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - M Deng
- Cartovera Pty. Ltd., Adelaide, SA, Australia
| | - S R Knowles
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Vic., Australia.,Department of Mental Health, St Vincent's Hospital, Fitzroy, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia
| | - K Sainsbury
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - B Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Bentley, WA, Australia
| | - J A Tye-Din
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia
| |
Collapse
|