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Parkinson A, Mullan B, Bebbington K, Davis E, Treadgold C, Finlay-Jones A. Wellbeing and distress in young people with chronic conditions: how do positive psychology variables relate to mental health outcomes? Health Psychol Behav Med 2023; 11:2274539. [PMID: 37941791 PMCID: PMC10629415 DOI: 10.1080/21642850.2023.2274539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The aim of this study was to determine the unique and shared contributions of various positive psychology constructs (gratitude, optimism, hope, self-compassion, self-efficacy, and emotion regulation) to wellbeing and distress outcomes in young people living with a diverse range of chronic health conditions. Methods and Measures 169 Australians (84.0% female, mean age = 21.2) who reported living with a chronic physical condition completed a cross-sectional survey assessing wellbeing, distress, and each positive psychology variable. Two multiple regressions were used to determine the unique and shared contributions of the positive psychology variables to wellbeing and distress outcomes. Results When considered alongside symptom severity, the variables explained 53.4% and 38.1% of variance in distress and wellbeing, respectively. Only optimism and self-efficacy accounted for unique and significant variance in the model predicting wellbeing, accounting for 6.1% and 4.6% of unique variance, respectively. For the distress model, optimism, self-compassion, and emotion regulation each accounted for significant variance. When considered alongside other variables, hope and gratitude did not contribute to either model. Conclusion Findings suggest that individual positive psychology variables differentially contribute to wellbeing and distress outcomes in young people with chronic conditions. Optimism appears to account for unique variance in both outcomes, suggesting it may be a parsimonious target to promote complete mental health in this population.
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Affiliation(s)
- Asha Parkinson
- Telethon Kids Institute, Nedlands, Australia
- enAble Institute, School of Population Health, Curtin University, Bentley, Australia
| | - Barbara Mullan
- enAble Institute, School of Population Health, Curtin University, Bentley, Australia
- WACPRU, School of Population Health, Curtin University, Bentley, Australia
| | - Keely Bebbington
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Elizabeth Davis
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Claire Treadgold
- Starlight Children’s Foundation, Naremburn, NSW, USA
- Discipline of Paediatrics & Child Health, UNSW, Medicine & Health, University of New South Wales, Sydney, NSW, USA
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Mathialagan K, Rondla M. Celiac disease and mental health - A concealed association. Am J Med Sci 2023; 365:545-546. [PMID: 36925063 DOI: 10.1016/j.amjms.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | - Madhumitha Rondla
- Department of Internal Medicine, Narayana Medical College, Nellore, India
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Schmidt JJ, Tolentino JC, Lacerda GCB, Schmidt GJ, van Duinkerken E, Schmidt SL. Cerebellar Symptoms in Gluten Sensitivity: a Systematic Review of the Effect of a Gluten-Free Diet on Brain Imaging. CEREBELLUM (LONDON, ENGLAND) 2022; 21:1014-1024. [PMID: 34633603 DOI: 10.1007/s12311-021-01331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
Cerebellar manifestations have been described in patients with gluten sensitivity (GS)-related disorders. A better understanding of the neurological manifestations of GS requires the use of neuroimaging techniques. We performed a systematic review on neuroimaging findings in GS patients with cerebellar symptoms. We also included a specific search on neuroimaging findings in GS patients with cerebellar manifestations on a gluten-free diet (GFD). PubMed, Embase, and Bireme were systematically searched to identify studies assessing neuroimaging features of adults with cerebellar manifestations and GS with or without enteropathy on a GFD. Ten studies with a total of 222 adult-GS patients were included. Magnetic resonance imaging was used in 100% of the studies. Cerebellar atrophy was evaluated in 7 studies and observed in 63% of the patients. White matter abnormalities were described in 2 studies. Single-photon emission computed tomography was used in 2 studies, and decreased cerebellar perfusion was detected in 92% of the included patients. No study employed nuclear medicine after the start of GFD. Magnetic resonance spectroscopy (MRS) was performed in 2 studies before and after GFD. An increase in the Naa/Cr ratio in cerebellar vermis was seen in 98% of the cases on a strict GFD. Cerebellar atrophy was found to be a prevalent condition in GS patients. MRS demonstrated to be useful in the follow-up of GS patients with cerebellar manifestations on a GFD. Prospective studies using nuclear medicine imaging are needed to study brain changes in GS patients on a GFD.
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Affiliation(s)
- Juliana J Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Zip Code 202709001, Brazil.
| | - Julio C Tolentino
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Zip Code 202709001, Brazil
| | - Glenda C B Lacerda
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Zip Code 202709001, Brazil
| | - Guilherme J Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Zip Code 202709001, Brazil
| | - Eelco van Duinkerken
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Zip Code 202709001, Brazil
| | - Sergio L Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Zip Code 202709001, Brazil
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Enaud R, Tetard C, Dupuis R, Laharie D, Lamireau T, Zerbib F, Rivière P, Shili-Mismoudi S, Poullenot F. Compliance with Gluten Free Diet Is Associated with Better Quality of Life in Celiac Disease. Nutrients 2022; 14:nu14061210. [PMID: 35334866 PMCID: PMC8951042 DOI: 10.3390/nu14061210] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
The quality of life (QOL) of patients with celiac disease (CD) can be altered by both symptoms of the disease and by the restrictions of the gluten-free diet (GFD). The objective was to determine the factors associated with better QOL in a large cohort of CD patients. A link to an online survey was sent to the members of the French Association of Gluten Intolerant People (AFDIAG). The French-Celiac Disease Questionnaire (F-CDQ), scoring from 0 to 100, was used to measure the QOL. Other data collected were sociodemographic characteristics, information on CD, purchasing and consumption habits of gluten-free products, and a self-assessment scale (ranging from 0 to 10) to determine the compliance with the GFD. Among the 907 CD patients who returned the questionnaire, 787 were analyzed (638 women (81%); median age: 49 years; 71% with self-assessed GFD compliance > 8). Their median F-CDQ was 73 (range: 59−82). In multivariate analysis, the main factors associated with a better quality of life were the long duration of the GFD, good compliance with the GFD, and the number of follow-up visits. Compliance with and duration of the GFD are associated with a better quality of life in patients with CD. Taking this into consideration would offset its restrictive aspect and improve its adherence.
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Affiliation(s)
- Raphaël Enaud
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Candice Tetard
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Raphaël Dupuis
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - David Laharie
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Thierry Lamireau
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Frank Zerbib
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Pauline Rivière
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Sarah Shili-Mismoudi
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Florian Poullenot
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
- Correspondence:
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Alkhayyat M, Qapaja T, Aggarwal M, Almomani A, Abureesh M, Al-Otoom O, Zmaili M, Mansoor E, Abou Saleh M. Epidemiology and risk of psychiatric disorders among patients with celiac disease: A population-based national study. J Gastroenterol Hepatol 2021; 36:2165-2170. [PMID: 33554378 DOI: 10.1111/jgh.15437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/12/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Celiac disease (CD) is a chronic disorder resulting from an immune reaction to gluten in genetically predisposed individuals. Although several studies have linked CD to psychiatric diseases, there are limited data on this topic. Using a large database, we sought to describe the epidemiology of several psychiatric disorders in CD. METHODS We queried a multicenter database (Explorys Inc), an aggregate of electronic health record data from 26 major integrated healthcare systems from 2016 to 2020 consisting of 360 hospitals in the USA. A cohort of patients with a Systematized Nomenclature Of Medicine - Clinical Terms diagnosis of CD was identified. Multivariate analysis was performed using Statistical Package for Social Sciences version 25. RESULTS Of the 37 465 810 patients in the database between 2016 and 2020, there were 112 340 (0.30%) individuals with CD. When compared with patients with no history of CD, patients with CD were more likely to have a history of anxiety (odds ratio [OR]: 1.385; 95% confidence interval [CI]: 1.364-1.407), depression (OR: 1.918; 95% CI: 1.888-1.947), bipolar (OR: 1.321; 95% CI: 1.289-1.354), attention-deficit hyperactivity disorder (OR: 1.753; 95% CI: 1.714-1.792), eating disorder (OR: 15.84; 95% CI: 15.533-16.154), and childhood autistic disorder (OR: 4.858; 95% CI: 3.626-6.508). Patients with CD and psychiatric conditions were more likely to be smokers, with history of alcohol and substance abuse as well as a history of personality disorder. CONCLUSIONS In this large database, patients with CD are at increased risk of having multiple psychiatric diseases including anxiety, depression, bipolar, attention-deficit hyperactivity disorder, eating disorder, and childhood autism. Individual care and referral to psychiatry when appropriate are warranted while taking care of this group of patients.
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Affiliation(s)
- Motasem Alkhayyat
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thabet Qapaja
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Manik Aggarwal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ashraf Almomani
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, New York City, New York, USA
| | - Omaymah Al-Otoom
- University of Jordan Medical School, University of Jordan, Amman, Jordan
| | - Mohammad Zmaili
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Emad Mansoor
- Department of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Person H, Keefer L. Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110209. [PMID: 33326819 PMCID: PMC8382262 DOI: 10.1016/j.pnpbp.2020.110209] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
The high comorbidity of psychological disorders in both functional and organic gastrointestinal diseases suggests the intimate and complex link between the brain and the gut. Termed the brain-gut axis, this bidirectional communication between the central nervous system and enteric nervous system relies on immune, endocrine, neural, and metabolic pathways. There is increasing evidence that the gut microbiome is a key part of this system, and dysregulation of the brain-gut-microbiome axis (BGMA) has been implicated in disorders of brain-gut interaction, including irritable bowel syndrome, and in neuropsychiatric disorders, including depression, Alzheimer's disease, and autism spectrum disorder. Further, alterations in the gut microbiome have been implicated in the pathogenesis of organic gastrointestinal diseases, including inflammatory bowel disease. The BGMA is an attractive therapeutic target, as using prebiotics, probiotics, or postbiotics to modify the gut microbiome or mimic gut microbial signals could provide novel treatment options to address these debilitating diseases. However, despite significant advancements in our understanding of the BGMA, clinical data is lacking. In this article, we will review current understanding of the comorbidity of gastrointestinal diseases and psychological disorders. We will also review the current evidence supporting the key role of the BGMA in this pathology. Finally, we will discuss the clinical implications of the BGMA in the evaluation and management of psychological and gastrointestinal disorders.
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Affiliation(s)
- Hannibal Person
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Laurie Keefer
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lexner J, Hjortswang H, Ekesbo R, Sjöberg K. Well-being and dietary adherence in patients with coeliac disease depending on follow-up. Scand J Gastroenterol 2021; 56:382-390. [PMID: 33621157 DOI: 10.1080/00365521.2021.1889024] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE It is not clear how follow-up of coeliac disease should be optimally organised. In Malmö, Sweden, patients are followed up by general practitioners (GP), but in Linköping by gastroenterologists (GE). The aim of this study was to investigate if there were any differences in well-being and dietary adherence depending on type of follow-up. METHODS All adult patients with newly diagnosed biopsy-verified coeliac disease in the cities between 2010 and 2014 were offered to participate. Data was retrieved comprising demography, laboratory analyses, questionnaires (Gastrointestinal Symptoms Rating Scale, Short Health Scale, Multidimensional Fatigue Inventory, Psychological General Well-being Index and Short Form 36) and follow-up. RESULTS In the GP cohort 39/73 patients and in the GE cohort 58/121 agreed to participate (mean age 43 and 44 years, 69 and 60% women, respectively). A follow-up to a dietician was carried out in 31% and 93% of patients, respectively (p < .001). In the GP group 28% had eaten gluten-containing food during the last 4 weeks compared to 9% in the GE group (p = .01). Despite this, no differences could be seen in vitamin or mineral levels. The questionnaires did not indicate any major discrepancies in subjective health. CONCLUSION Irrespective of the design of the follow-up physical and mental well-being were comparable. Dietary adherence was not quite as good in the GP group but follow-up in a primary care setting can still be a suitable and equivalent alternative. However, it is crucial that the dietary counselling is structured in a way that ensures dietary adherence.
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Affiliation(s)
- Jesper Lexner
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden.,Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Rickard Ekesbo
- Department of Clinical Sciences, Lund University, Vårdhuset Malmö, Sweden
| | - Klas Sjöberg
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
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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.
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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
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Atsawarungruangkit A, Silvester JA, Weiten D, Green KL, Wilkey KE, Rigaux LN, Bernstein CN, Graff LA, Walker JR, Duerksen DR. Development of the Dietitian Integrated Evaluation Tool for Gluten-free Diets (DIET-GFD). Nutrition 2020; 78:110819. [PMID: 32544849 PMCID: PMC7502431 DOI: 10.1016/j.nut.2020.110819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/14/2019] [Accepted: 03/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Celiac disease (CD) treatment involves a gluten-free diet (GFD). There is no standardized tool for dietitians to objectively grade GFD adherence. This study aimed to develop a standardized tool for dietitians to evaluate and communicate GFD adherence. METHODS Participants were recruited from the Manitoba Celiac Disease Cohort. Using a consensus process, an expert panel of gastroenterologists, dietitians, clinical health psychologists, and persons with CD developed the Dietitian Integrated Evaluation Tool for Gluten-free Diets (DIET-GFD). Two dietitians performed duplicate assessments of 27 newly diagnosed participants who had been advised to follow a GFD. The global adherence scale was further revised after panel discussions of the cases where there was uncertainty or discordance on dietitian ratings. Subsequently, the scoring system was evaluated using duplicate assessments of an additional 37 participants with CD. Interrater agreement was assessed using square-weight Cohen's kappa. RESULTS The DIET-GFD includes features related to frequency and quantity of gluten ingestion based on self-reporting and food frequency evaluation, shopping and dining habits, how and where food is prepared and consumed, eating behaviors, and label reading skills. The DIET-GFD global assessment is reported using a 10-point ordinal descriptive scale, ranging from 1 (takes few precautions and regularly eats gluten) to 10 (no gluten in kitchen and rarely eats food prepared outside the home). The kappa of DIET-GFD global assessment was 0.845, which indicates excellent agreement. CONCLUSIONS DIET-GFD is a useful tool for dietitians to evaluate GFD adherence. Further studies are needed to confirm that the score from the DIET-GFD is reliable across various settings.
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Affiliation(s)
- Amporn Atsawarungruangkit
- Harvard Medical School, Celiac Research Program, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; MetroWest Medical Center, Framingham, Massachusetts, USA
| | - Jocelyn A Silvester
- Harvard Medical School, Celiac Research Program, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Dayna Weiten
- Grace General Hospital, Winnipeg, Manitoba, Canada
| | | | - Kaitlyn E Wilkey
- Harvard Medical School, Celiac Research Program, Boston, Massachusetts, USA
| | | | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Walker
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Donald R Duerksen
- St. Boniface Hospital, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Falato E, Capone F, Ranieri F, Florio L, Corbetto M, Taffon C, Niolu C, Di Lorenzo G, Di Lazzaro V. Celiac Disease Diagnosed in an Older Adult Patient with a Complex Neuropsychiatric Involvement: A Case Report and Review of the Literature. Brain Sci 2020; 10:brainsci10070426. [PMID: 32635319 PMCID: PMC7408423 DOI: 10.3390/brainsci10070426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
We present a case of celiac disease (CD) diagnosis in a 75-year-old woman with a long-term history of chronic delusional jealousy and a complex neurological involvement. The case describes a very unusual clinical picture, provides some clinical clues, and highlights the importance of being aware of CD extraintestinal manifestations in order to get a timely diagnosis.
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Affiliation(s)
- Emma Falato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.C.)
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.C.)
| | - Federico Ranieri
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Lucia Florio
- Unit of Neurology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Marzia Corbetto
- Department of Neurology, Santa Maria Goretti Hospital, 04100 Latina, Italy;
| | - Chiara Taffon
- Unit of Pathology, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy;
| | - Cinzia Niolu
- Unit of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (C.N.); (G.D.L.)
| | - Giorgio Di Lorenzo
- Unit of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (C.N.); (G.D.L.)
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.C.)
- Correspondence:
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Croall ID, Sanders DS, Hadjivassiliou M, Hoggard N. Cognitive Deficit and White Matter Changes in Persons With Celiac Disease: A Population-Based Study. Gastroenterology 2020; 158:2112-2122. [PMID: 32088203 DOI: 10.1053/j.gastro.2020.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/24/2019] [Accepted: 02/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS There is debate over the presence and prevalence of brain injury in patients with celiac disease. To validate previous reports, we investigated the prevalence of neuropsychological dysfunction in persons with celiac disease included in the National UK Biobank, which contains experimental medical data from 500,000 adults in the United Kingdom. METHODS Biobank participants with celiac disease (n = 104; mean age, 63 years; 65% female) were matched with healthy individuals (controls, n = 198; mean age, 63 years; 67% female) for age, sex, level of education, body mass index, and diagnosis of hypertension. All participants were otherwise healthy. We compared scores from 5 cognitive tests and multiple choice responses to 6 questions about mental health between groups using the t test and chi-squared analyses. Groupwise analyses of magnetic resonance imaging brain data included a study of diffusion tensor imaging metrics (mean diffusivity, fractional anisotropy, radial diffusivity, axial diffusivity), voxel-based morphometry, and Mann-Whitney U comparisons of Fazekas grades. RESULTS Compared with control individuals, participants with celiac disease had significant deficits in reaction time (P = .004), and significantly higher proportions had indications of anxiety (P = .025), depression (P = .015), thoughts of self-harm (P = .025), and health-related unhappiness (P = .010). Tract-based spatial statistics analysis showed significantly increased axial diffusivity in widespread locations, demonstrating white matter changes in the brains of participants with celiac disease. Voxel-based morphometry and Fazekas grade analyses did not differ significantly between groups. CONCLUSIONS In an analysis of data from the UK Biobank, we found participants with celiac disease to have cognitive deficit, indications of worsened mental health, and white matter changes, based on analyses of brain images. These findings support the concept that celiac disease is associated with neurologic and psychological features.
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Affiliation(s)
- Iain D Croall
- University of Sheffield, Academic Unit of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom; University of Sheffield, Institute for in silico Medicine (INSIGNEO), Sheffield, United Kingdom.
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Marios Hadjivassiliou
- Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Nigel Hoggard
- University of Sheffield, Academic Unit of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom; University of Sheffield, Institute for in silico Medicine (INSIGNEO), Sheffield, United Kingdom
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12
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Harnett JE, Myers SP. Quality of life in people with ongoing symptoms of coeliac disease despite adherence to a strict gluten-free diet. Sci Rep 2020; 10:1144. [PMID: 31980719 PMCID: PMC6981136 DOI: 10.1038/s41598-020-58236-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 01/02/2020] [Indexed: 12/13/2022] Open
Abstract
People with Coeliac disease who suffer persistent symptoms despite adherence to a gluten-free diet are at a greater risk of a reduced health related quality of life. The purpose of this paper is to report the quality of life experienced by this specific group of patients in Australia. A Coeliac Disease Specific Questionnaire (CDQ) was administered to 45 people who were enrolled in a clinical trial and reported persistent symptoms of Coeliac disease despite adherence to a strict gluten free diet. The clinical trial was based in New South Wales, Australia. The instrument used was a subscale and total scores of a CDQ measuring health related quality of life. At baseline the overall mean CDQ score was 147 ± 3.31 (optimum 196) consisting of 4 subscales; gastrointestinal 33 ± 0.88, emotional 32.9 ± 0.99, worries 39.8 ± 0.79 and social 41 ± 6.12 each with a potential score of 49. The health related quality of life of people reporting persistent symptoms of Coeliac disease despite adherence to a gluten free diet is sub-optimal with concerningly low scores for emotional quality.
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Affiliation(s)
- Joanna E Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Stephen P Myers
- NatMed-Research, Division of Research, Southern Cross University, Lismore, Australia
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13
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Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12010142. [PMID: 31947912 PMCID: PMC7019223 DOI: 10.3390/nu12010142] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Coeliac disease (CD) is increasingly prevalent and is associated with both gastrointestinal (GI) and extra-intestinal manifestations. Psychiatric disorders are amongst extra-intestinal manifestations proposed. The relationship between CD and such psychiatric disorders is not well recognised or understood. Aim: The aim of this systematic review and meta-analysis was to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of CD. Methodology: An online literature search using PubMed was conducted, the prevalence data for both CD and psychiatric disorders was extracted from eligible articles. Meta analyses on odds ratios were also performed. Results: A total of 37 articles were included in this review. A significant increase in risk was detected for autistic spectrum disorder (OR 1.53, 95% CI 1.24–1.88, p < 0.0001), attention deficit hyperactivity disorder (OR 1.39, 95% CI 1.18–1.63, p < 0.0001), depression (OR 2.17, 95% CI 2.17–11.15, p < 0.0001), anxiety (OR 6.03, 95% CI 2.22–16.35, p < 0.0001), and eating disorders (OR 1.62, 95% CI 1.37–1.91, p < 0.00001) amongst the CD population compared to healthy controls. No significant differences were found for bipolar disorder (OR 2.35, 95% CI 2.29–19.21, p = 0.43) or schizophrenia (OR 0.46, 95% CI 0.02–10.18, p = 0.62). Conclusion: CD is associated with an increased risk of depression, anxiety, eating disorders as well as ASD and ADHD. More research is required to investigate specific biological explanations as well as any effect of gluten free diet.
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14
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Coburn S, Rose M, Streisand R, Sady M, Parker M, Suslovic W, Weisbrod V, Kerzner B, Kahn I. Psychological Needs and Services in a Pediatric Multidisciplinary Celiac Disease Clinic. J Clin Psychol Med Settings 2019; 27:433-443. [DOI: 10.1007/s10880-019-09673-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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15
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Stocks NP, Gonzalez-Chica D, Hay P. Impact of gastrointestinal conditions, restrictive diets and mental health on health-related quality of life: cross-sectional population-based study in Australia. BMJ Open 2019; 9:e026035. [PMID: 31253614 PMCID: PMC6609067 DOI: 10.1136/bmjopen-2018-026035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess the relationship between gastrointestinal conditions, restrictive diets, mental health and health-related quality of life (HRQoL). DESIGN Cross-sectional population-based face-to-face survey. SETTING South Australia. PARTICIPANTS A representative sample of 2912 consenting adults (48.9±18.1 years; 50.9% females) investigated in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Participants self-reported diagnosis of gastrointestinal conditions, mental health and current use of restrictive diets. The physical component score (PCS) and mental component score (MCS) of HRQoL were investigated (Study Short Form 12 V.1 questionnaire). Linear regression models were used to test the associations, adjusting for (1) sociodemographic variables, (2) mental health status and (3) lifestyle and body mass index. RESULTS The prevalence of restrictive diets (36.1%; 95% CI 33.9 to 38.3) was higher among those with any self-reported gastrointestinal condition (60.7% vs 31.3% for those without these conditions; p<0.001). PCS was lower among those with a gastrointestinal condition (mean difference=-3.4; 95% CI -4.5 to -2.4) or on a restrictive diet (mean difference=-1.9; 95% CI -2.7 to -1.1), with a similar pattern, but with a smaller effect, observed for MCS. Being on a restrictive diet did not modify the relationship between having a gastrointestinal condition and reduced HRQoL. However, having a gastrointestinal condition was associated with a 2.4 points lower PCS (95% CI -3.5 to -1.3) among those without a mental health problem, while for those affected by a mental health condition this reduction was greater (mean difference=-5.9; 95% CI -8.7 to -3.1). For MCS, there was no evidence of interaction between mental health and gastrointestinal conditions. CONCLUSIONS One-third of Australian adults are restricting their diet, and this is associated with lower HRQoL. Being on a restrictive diet was not associated with a better HRQoL among individuals with a gastrointestinal condition. Mental health problems were associated with a stronger adverse relationship between gastrointestinal diseases and physical HRQoL. Health professionals should be alert to these associations when trying to improve health outcomes for patients.
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Affiliation(s)
- Nigel P Stocks
- General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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16
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Martínez-Martinez MI, Alegre-Martínez A, García-Ibánez J, Cauli O. Quality of Life in People with Coeliac Disease: Psychological and Socio- Economic Aspects. Endocr Metab Immune Disord Drug Targets 2019; 19:116-120. [PMID: 30033882 DOI: 10.2174/1871530318666180723100003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Coeliac disease (CD) is a chronic autoimmune intestinal disorder characterized by intolerance to gluten, a protein contained in certain cereals. The main physiopathological basis of CD is the progressive destruction of intestinal villi caused by gluten ingestion by genetically-susceptible individuals. Patients who receive a diagnosis of CD must make significant changes to their daily habits and this can affect their quality of life. The objective of this review is to summarize the evidence regarding the economic, physical and social limitations which can affect the quality of life in patients with CD. RESULTS Different factors such as physical changes, psychological effects, interpersonal relationships, emotions and economic difficulties can affect the quality of life of these patients. Observations suggest that, in general, women with CD experience a greater deterioration in their quality of life than men. Lastly, complications in daily life are also associated with the reduced availability of gluten-free products which also usually cost more than standard products. CONCLUSIONS Continuous health education and care regarding socio-economic issues should be continuously developed and provided to people with CD.
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Affiliation(s)
- Maria Isabel Martínez-Martinez
- Departamento de Enfermeria. Facultad de Enfermeria y Podologia, Universidad de Valencia. C/ Jaume Roig, s/n, 46001 Valencia, Spain
| | - Antoni Alegre-Martínez
- Departamento de Ciencias Biomédicas, Universidad Cardenal Herrera CEU. Avenida Seminario, s/n, 46113 Montcada, Valencia, Spain
| | - Jessica García-Ibánez
- Departamento de Enfermeria. Facultad de Enfermeria y Podologia, Universidad de Valencia. C/ Jaume Roig, s/n, 46001 Valencia, Spain
| | - Omar Cauli
- Departamento de Enfermeria. Facultad de Enfermeria y Podologia, Universidad de Valencia. C/ Jaume Roig, s/n, 46001 Valencia, Spain
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Norwood R, Cruwys T, Chachay VS, Sheffield J. The psychological characteristics of people consuming vegetarian, vegan, paleo, gluten free and weight loss dietary patterns. Obes Sci Pract 2019; 5:148-158. [PMID: 31019732 PMCID: PMC6469437 DOI: 10.1002/osp4.325] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Previous research has identified several psychological factors associated with dietary restriction but has focused almost exclusively on the subcategory of people following a weight loss diet. Little is known about the psychological factors associated with other kinds of restrictive dietary patterns. Furthermore, it remains unclear whether the identified psychological characteristics of dieters (e.g. elevated disordered eating behaviours, poor well-being) are a cause of dieting, follow from calorie restriction or are the result of cognitive restraint. METHODS This study conducted the first direct comparison of people (N = 393) following five different restrictive dietary patterns (vegetarian, vegan, gluten free, paleo and weight loss) as well as a comparison group who were not following a specific dietary pattern. RESULTS The weight loss group had more negative psychological characteristics than all other groups, reporting the highest levels of eating disorder symptoms (M = 1.50), food cravings (M = 69.39), emotional eating (M = 2.97) and negative affect (M = 19.72). By contrast, several of the other restrictive dietary groups showed a number of psychological strengths, relative to the comparison group. This was particularly apparent among the paleo group, who reported the lowest levels of eating disorder symptoms (M = 0.74), food cravings (M = 47.63), emotional eating (M = 2.30) and negative affect (M = 14.81). By contrast, people following vegetarian and gluten free diets were largely the same as the non-restricted comparison group in their psychological characteristics. CONCLUSIONS People adhering to different dietary patterns showed stark differences in their psychological characteristics. Indeed, some restrictive dietary patterns (paleo and vegan) were associated with more positive psychological characteristics than seen in an unrestricted comparison group. This suggests that the psychological risk factors seen in weight loss dieters are not attributable to a restrictive dietary regimen per se.
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Affiliation(s)
- R. Norwood
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
| | - T. Cruwys
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
- Research School of PsychologyAustralian National UniversityCanberraAustralia
| | - V. S. Chachay
- School of Human Movement and Nutrition SciencesUniversity of QueenslandBrisbaneAustralia
| | - J. Sheffield
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
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18
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Lerner A, O'Bryan T, Matthias T. Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet. Front Pediatr 2019; 7:414. [PMID: 31681712 PMCID: PMC6803387 DOI: 10.3389/fped.2019.00414] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/26/2019] [Indexed: 12/18/2022] Open
Abstract
In gluten dependent conditions the gluten free diet is the cornerstone of therapy, decreasing disease activity, improving health and quality of life and treating or preventing the associated complications. Gluten withdrawal implies strict and lifelong elimination not only of wheat, barley, rye, and wheat-contaminated oats, but also of numerous non-nutritional products where components of wheat are often added. Due to multiple reasons the diet is difficult to follow and the long-term adherence is decreased with time. The present review summarizes the dark side of gluten restriction where nutritional deficiencies, toxicity, morbidity, mortality, and mental health problems are reported. The aim being to increase awareness, avoid, detect and treat the side effects and to promote a healthier nutrition, for the patient's benefits.
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Affiliation(s)
| | - Thomas O'Bryan
- Gastroenterology, Clinical Practice and Institute of Functional Medicine, The National University of Health Sciences, San Diego, CA, United States
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19
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Knowles SR, Mikocka-Walus A. Editorial: anxiety and depression associated with mucosal healing in coeliac disease. Aliment Pharmacol Ther 2018; 48:1314-1315. [PMID: 30488619 DOI: 10.1111/apt.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Simon R Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, Vic., Australia
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20
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Roncoroni L, Bascuñán KA, Doneda L, Scricciolo A, Lombardo V, Branchi F, Ferretti F, Dell'Osso B, Montanari V, Bardella MT, Elli L. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients 2018; 10:E1023. [PMID: 30081576 PMCID: PMC6115770 DOI: 10.3390/nu10081023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
A subset of patients with celiac disease (CD) on a gluten-free diet (GFD) reported the persistence of functional gastrointestinal disorders. Foods containing fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can trigger a broad range of gastrointestinal symptoms in sensitive individuals. We evaluated the effects of a low FODMAP diet (LFD) on gastrointestinal and psychological symptomatology in CD patients. A total of 50 celiac patients on GFDs and with persistence of gastrointestinal symptoms were included. The patients were randomly allocated to one of two dietary groups-one on a low FODMAP GFD (LF-GFD, n = 25) and the other on a regular GFD (R-GFD, n = 25)-for 21 days. Psychological symptomatology and quality of life were evaluated by the Symptom Checklist-90-R (SCL-90) and the Short Form (36) Health Survey (SF-36) questionnaires, respectively. Gastrointestinal symptomatology and general well-being were evaluated by visual analogue scale (VAS) scores. After 21 days, 21 and 23 patients completed the dietary treatment on LF-GFD and R-GFD, respectively. A reduced global SCL-90 index (p < 0.0003) was found in the LF-GFD group but not in the R-GFD one. However, the SF-36 scores did not differ between groups after treatment. The VAS for abdominal pain was much lower, and the VAS for fecal consistency enhanced after treatment in the LF-GFD group. General well-being increased in both groups but with a much higher improvement in the LF-GFD (p = 0.03). A short-term LFD regimen helps to improve the psychological health and gastrointestinal symptomatology with enhanced well-being of CD patients with persisting functional gastrointestinal symptomatology. The long-term clinical effects of LFD in particular subgroups of CD patients need further evaluation.
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Affiliation(s)
- Leda Roncoroni
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20100 Milan, Italy.
| | - Karla A Bascuñán
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Nutrition, University of Chile, 8380453 Santiago, Chile.
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20100 Milan, Italy.
| | - Alice Scricciolo
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Vincenza Lombardo
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Federica Branchi
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Francesca Ferretti
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Bernardo Dell'Osso
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy.
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA 94305-5723, USA.
- CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, 20100 Milan, Italy.
| | - Valeria Montanari
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Maria Teresa Bardella
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Luca Elli
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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Cognitive Impairment and Celiac Disease: Is Transcranial Magnetic Stimulation a Trait d'Union between Gut and Brain? Int J Mol Sci 2018. [PMID: 30065211 DOI: 10.3390/ijms19082243.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Celiac disease is a systemic disorder with multifactorial pathogenesis and multifaceted symptomatology. In response to gluten exposure, a significant part of the general population produces antibodies that have been hypothesized to be deleterious to the brain. Among the well-known neurological manifestations, adult celiac patients often complain cognitive symptoms, ranging from the so-called "brain fog" till an overt dementia. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that can contribute to the assessment and monitoring of celiac patients, even in those without a clear neurological involvement. The studies here reviewed seem to converge on an impaired central motor conductivity and a "hyperexcitable celiac brain" to TMS, which partially reverts back after a long-term gluten restriction. Notably, a clear hyperexcitability is a stably reported feature of both degenerative and vascular dementia. Therefore, given its potential neuroprotective effect, the gluten-free diet should be introduced as early as possible, although the overall response of neurological symptoms (and cognition in particular) is still controversial. Identifying new and possibly modifiable risk factors may be of crucial importance for patients, clinicians, and researchers.
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Lanza G, Bella R, Cantone M, Pennisi G, Ferri R, Pennisi M. Cognitive Impairment and Celiac Disease: Is Transcranial Magnetic Stimulation a Trait d'Union between Gut and Brain? Int J Mol Sci 2018; 19:ijms19082243. [PMID: 30065211 PMCID: PMC6121508 DOI: 10.3390/ijms19082243] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 02/07/2023] Open
Abstract
Celiac disease is a systemic disorder with multifactorial pathogenesis and multifaceted symptomatology. In response to gluten exposure, a significant part of the general population produces antibodies that have been hypothesized to be deleterious to the brain. Among the well-known neurological manifestations, adult celiac patients often complain cognitive symptoms, ranging from the so-called "brain fog" till an overt dementia. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that can contribute to the assessment and monitoring of celiac patients, even in those without a clear neurological involvement. The studies here reviewed seem to converge on an impaired central motor conductivity and a "hyperexcitable celiac brain" to TMS, which partially reverts back after a long-term gluten restriction. Notably, a clear hyperexcitability is a stably reported feature of both degenerative and vascular dementia. Therefore, given its potential neuroprotective effect, the gluten-free diet should be introduced as early as possible, although the overall response of neurological symptoms (and cognition in particular) is still controversial. Identifying new and possibly modifiable risk factors may be of crucial importance for patients, clinicians, and researchers.
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Affiliation(s)
- Giuseppe Lanza
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73-94018 Troina, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Via S. Sofia, 78-95123 Catania, Italy.
| | - Mariagiovanna Cantone
- IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy.
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via S. Sofia, 78-95123 Catania, Italy.
| | - Raffaele Ferri
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73-94018 Troina, Italy.
| | - Manuela Pennisi
- Spinal Unit, Emergency Hospital Cannizzaro, Via Messina, 829-95126 Catania, Italy.
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23
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Slim M, Rico-Villademoros F, Calandre EP. Psychiatric Comorbidity in Children and Adults with Gluten-Related Disorders: A Narrative Review. Nutrients 2018; 10:E875. [PMID: 29986423 PMCID: PMC6073457 DOI: 10.3390/nu10070875] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/26/2018] [Accepted: 07/04/2018] [Indexed: 12/22/2022] Open
Abstract
Gluten-related disorders are characterized by both intestinal and extraintestinal manifestations. Previous studies have suggested an association between gluten-related disorder and psychiatric comorbidities. The objective of our current review is to provide a comprehensive review of this association in children and adults. A systematic literature search using MEDLINE, Embase and PsycINFO from inception to 2018 using terms of ‘celiac disease’ or ‘gluten-sensitivity-related disorders’ combined with terms of ‘mental disorders’ was conducted. A total of 47 articles were included in our review, of which 28 studies were conducted in adults, 11 studies in children and eight studies included both children and adults. The majority of studies were conducted in celiac disease, two studies in non-celiac gluten sensitivity and none in wheat allergy. Enough evidence is currently available supporting the association of celiac disease with depression and, to a lesser extent, with eating disorders. Further investigation is warranted to evaluate the association suggested with other psychiatric disorders. In conclusion, routine surveillance of potential psychiatric manifestations in children and adults with gluten-related disorders should be carried out by the attending physician.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada.
| | - Fernando Rico-Villademoros
- Instituto de Neurociencias, Universidad de Granada, Avenida del Conocimiento s/n, 18100 Armilla, Granada, Spain.
| | - Elena P Calandre
- Instituto de Neurociencias, Universidad de Granada, Avenida del Conocimiento s/n, 18100 Armilla, Granada, Spain.
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24
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Night terrors associated with celiac disease. Eur J Gastroenterol Hepatol 2018; 30:687-688. [PMID: 29697525 DOI: 10.1097/meg.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Zylberberg HM, Ludvigsson JF, Green PHR, Lebwohl B. Psychotropic medication use among patients with celiac disease. BMC Psychiatry 2018; 18:76. [PMID: 29580225 PMCID: PMC5870752 DOI: 10.1186/s12888-018-1668-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Celiac disease is a multi-system disorder with manifestations that may result in psychiatric disorders. We assessed the prevalence of medication use to treat psychiatric disorders in celiac disease patients. METHODS We conducted a cross-sectional study of patients undergoing esophagogastroduodenoscopy over 9-years at a celiac disease referral center. We compared the prevalence of psychotropic medication use among celiac disease patients (n = 1293) to a control group (n = 1401) with abdominal pain or reflux. RESULTS Among all patients the mean age was 48.4 years, most were female (69.5%), and 22.7% used any psychotropic medication. There was no difference between overall psychotropic medication use among celiac disease patients and controls (23.9% vs 21.8%, OR 1.16; 95% CI 0.96-1.39, p = 0.12). However, those with celiac disease were more likely to use antidepressants on univariate (16.4% vs 13.4%, p = 0.03) and multivariate analysis (OR 1.28; 95% CI 1.03-1.59; p = 0.03). Use of psychotropic medications was not associated with disease duration or mode of presentation of celiac disease. CONCLUSIONS Celiac disease patients use psychotropic medications at similar rates as those with other gastrointestinal diseases, though subgroup analysis suggests they may use more antidepressants. Future studies should investigate whether celiac disease is associated with mood disorders that are not treated with medications.
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Affiliation(s)
- Haley M. Zylberberg
- 0000000419368729grid.21729.3fDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA ,0000000419368729grid.21729.3fThe Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Jonas F. Ludvigsson
- 0000000419368729grid.21729.3fDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA ,0000 0000 9241 5705grid.24381.3cDepartment of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden ,0000 0001 0123 6208grid.412367.5Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Peter H. R. Green
- 0000000419368729grid.21729.3fDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA ,0000000419368729grid.21729.3fThe Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA. .,Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. .,The Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA.
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Carta MG, Patten S, Nardi AE, Bhugra D. Mental health and chronic diseases: a challenge to be faced from a new perspective. Int Rev Psychiatry 2017; 29:373-376. [PMID: 28911265 DOI: 10.1080/09540261.2017.1364885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mauro Giovanni Carta
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Scott Patten
- b Department of Community Health Sciences , University of Calgary , Calgary , AB , Canada
| | - António E Nardi
- c Faculdade de Medicina , Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brasil.,d Academia Nacional de Medicina , Rio de Janeiro , Brasil
| | - Dinesh Bhugra
- e Emeritus Professor of Mental Health and Cultural Diversity, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK.,f World Psychiatric Association , Geneva , Switzerland
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