Anxiety Symptoms in Adult Celiac Patients and the Effect of a Gluten-Free Diet: An Iranian Nationwide Study

Assessing the Impact of a Gluten-Free Diet on Celiac Disease Symptoms in Children: A Comprehensive Review

Celiac disease, a serious autoimmune disease, is triggered by the ingestion of gluten. It is associated with many gastrointestinal and extraintestinal symptoms. The cornerstone of treatment is a strict gluten-free diet (GFD). This paper collected studies that were screened between the 15th and 25th of June 2024 and were searched for from many databases and registers, including PubMed, Medline, ClinicalTrials.gov, Cochrane Library, Europe PMC, and EBSCO Open Dissertations. We have included the 12 most relevant studies that examined the effects of GFD adherence among pediatric patients with celiac disease. Evidence suggests that a GFD caused notable improvements in liver function, growth metrics, and quality of life indices. Extraintestinal symptoms such as cardiac dysfunctions and obstructive sleep apnea also showed compelling improvement. We conclude that there are substantial advantages of a GFD in children with celiac disease and call for the need for personal nutritional support to address nutritional deficiencies and long-term studies and comprehensive strategies to optimize treatment outcomes and improve the quality of life for affected children.

Dietary eating patterns, dairy consumption, and anxiety: A systematic literature review

BACKGROUND

Nutrition affects both physical and mental health but evidence is mixed regarding potential associations between anxiety and diet, particularly dairy consumption. We conducted a systematic literature review (SLR) of dairy consumption and/or various dietary patterns and risk of anxiety.

METHODS

Literature searches were conducted in PubMed and Embase. All study designs except case reports, small case series, and SLRs were considered for inclusion. Reference lists of previously published SLRs were reviewed for any relevant additional studies. Studies of populations without dairy sensitivities exploring the association between dietary patterns and/or dairy consumption and anxiety published through May 2022 were identified using predefined eligibility criteria. Study quality was determined using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

For this SLR, 132 studies were included; 80 were cross-sectional. Studies examined different dietary patterns (e.g., Mediterranean, gluten-free) and anxiety using various anxiety scales, with 19 studies specifically reporting on whole dairy consumption and anxiety. Dairy consumption was significantly associated with a lower risk of anxiety in 7 studies, while the remaining 12 studies showed no significant associations. Evidence was mixed for the association between various dietary patterns and anxiety, but more studies observed a lower risk of anxiety with greater adherence to "healthy" diets (e.g., Mediterranean, diet quality score, vegetarian/vegan) than a higher risk. Notable heterogeneity in study populations, time periods, geographical locations, dietary assessment methods, and anxiety scales was observed.

CONCLUSIONS

The results of this SLR suggest a potential link between diet including diary consumption and anxiety, but future studies, especially with longitudinal designs that measure diet and anxiety at several timepoints and comprehensively adjust for confounders, are needed to fully understand the relationship between diet and anxiety.

The Prevalence of Anxiety and Depressive Symptoms Among Patients With Celiac Disease in Jordan

Background Celiac disease is an immune-mediated intestinal disorder with a global prevalence of 1% that results from gluten sensitivity in a genetically susceptible person. It presents with gastrointestinal symptoms, consequences of malabsorption, and/or extraintestinal manifestations that include neuropsychiatric symptoms. Aim The aim of this study was to measure the frequency of anxiety and depressive symptoms in Jordanian patients with celiac disease. Methods This was a cross-sectional study. A questionnaire was sent electronically to celiac disease patients who were members of the Friends of Celiac Disease Patients Association through WhatsApp using Google Forms (Google, Mountain View, California). The questionnaire contained demographic and disease-related questions, in addition to questions that assessed anxiety and depressive symptoms using validated Arabic versions of the Generalized Anxiety Disorder-7 score and Patient Health Questionnaire-9, respectively. Results A total of 133 patients answered the questionnaires. Of the respondents, 82.7% were females, and the mean age was 33.9 +/- 11.22 years; 31.6% of patients were non-compliant with a gluten-free diet, and 56.4% were symptomatic at the time of the questionnaire. The prevalence of anxiety and depressive symptoms were 85% and 82.7%, respectively. There was no correlation between any of the variables and the presence of anxiety or depressive symptoms. Conclusion A significant proportion of celiac disease patients in Jordan have evidence of anxiety and depressive symptoms. Given this high prevalence and the possible impact on the quality of life, physicians need to screen patients for the presence of psychiatric comorbidities and refer those who have symptoms for further evaluation.

Cognitive Impairment in Celiac Disease Patients: Scoping Review Exploring Psychological Triggers in a Chronic Condition

Celiac disease (CD), also known as gluten-sensitive enteropathy, is an inflammatory autoimmune reaction triggered by ingestion of gluten in genetically predisposed subjects. Celiac disease is often associated with a wide range of disorders, caused by immune responses and by malabsorption with subsequent nutritional deficiencies. Prevalent neurologic manifestations are ataxia, epilepsy, cerebral calcification, cerebral white matter lesions, peripheral neuropathy and myopathy, but also cognitive impairment. The study aimed to identify emerging and urgent research domains in order to establish a CD-specific patient-tailored protocol that includes both psychological and neuropsychological evaluations. We performed a systematic search of MEDLINE, PubMed, SCOPUS, Web of Science and Cochrane library in November 2022. We conducted a descriptive analysis of the characteristics of the included literature. Based on the exclusion/inclusion criteria, a total of seven articles were included in the scoping review process. This review demonstrated the lack of research on CD-related cognitive impairment key features and tries to focus on both cognitive and psychological manifestations as well as their two-way interaction. We tried to establish the specific areas involved, in order to have a comprehensive view of this condition and trying to determine a correct way of assessing CD cognitive impairment and its correlations with psychological distress and personal coping skills to a chronic condition. Nevertheless, research on this topic is progressively increasing and future studies should address specific key points.

Relationship between anxiety and quality of life in the presence of other factors in adult celiac patients; a nationwide study

Aim

This study aimed to detect relationships among quality of life (QoL) and anxiety and demographic factors in patients with celiac disease (CD).

Background

CD is a type of autoimmune small intestine diseases caused by gluten ingestion. In Iran, the prevalence of CD is considered to be 1% in the general population. As physical problems and behavioral disorders of CD can lead to a reduction in QoL.

Methods

This cross-sectional study was performed on 533 patients with Celiac Disease from 9 cities of Iran. Data collected were analyzed by SPSS version 22. Quality of life and anxiety respectively evaluated by (GHQ-28) and SAS questionnaires. Predictors of quality of life (sex, age, age of diagnosis, city of life, education level, family history of celiac, occupation and anxiety) were tested by multiple linear regression.

Results

Our results showed a significant relationship between poor quality of life and anxiety (correlation= -0.143, P=0.001). The mean of the quality of life index in celiac diseases was 126.2±30.4 and women had a lower quality of life than men (P=0.003) importantly in emotions and worries scores. There was no significant difference between male and female in terms of anxiety level.

Conclusion

According to the results, both quality of life and anxiety correlated together and women seem to suffer more than men from celiac disease. Therefore, greater attention to women who have celiac disease are suggested.

The Effect of Gluten-Free Diet Duration on Body Mass Index of Iranian Patients with Celiac Disease

Background: A gluten-free diet (GFD) is the only effective treatment of celiac disease (CD) that is associated with body mass index (BMI) changes. This study aimed to determine how GFD duration affects the BMI of Iranian patients with CD. Methods: In this prospective study, 215 patients with CD, who were on a GFD, were categorized into three groups according to the duration of compliance to GFD: 1. patients with less than 6 months of diet, 2. Patients who had a diet for 6 months to 2 years, and 3. patients with more than 2 years of diet. The BMI changes were assessed before and after adherence to the GFD. Results: Most patients' weight remains in the same BMI category during different courses of GFD adherence. Patients who were underweight showed significant changes in their BMI following the diet in less than 6 months (P=0.033) and more than 2 years (P<0.001), and the number of weight gain cases increased over time. Conclusion: There is a need for careful, updated, and personalized nutrition management of patients with CD in different periods of the diet. Conducting similar studies with larger sample sizes in different regions can lead to providing expert dietary counseling for patients with CD.

Effects of a gluten challenge in patients with irritable bowel syndrome: a randomized single-blind controlled clinical trial

Non-celiac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS) frequently overlap. Although, gluten-free diet (GFD) and low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improve the IBS clinical picture, many aspects remain unclear. Therefore, we designed a study to evaluate gluten tolerance, anxiety and quality of life in a specific study population. Fifty IBS patients were asked to follow a low FODMAP strict GFD for 6 weeks and were then randomly allocated to the following groups for a further 6 weeks: (A) receiving 8 g/day of gluten for 2 weeks; gluten-tolerating subjects received 16 g/day for 2 weeks and then 32 g/day for a further 2 weeks; (B) continuing to follow a low FODMAP strict GFD; and (C) receiving a gluten-containing diet. After the first 6 weeks, symptom scores significantly improved. Pain severity, bloating and total score were significantly decreased in the GFD and in the high-gluten groups, while the satiety score significantly increased in group C. Between-group analysis revealed significant differences for pain severity (p = 0.02), pain frequency (p = 0.04) and impact on community function (p = 0.02) at the end of the study. Our findings suggest that low FODMAP strict GFD could be prescribed in IBS patients and would reduce anxiety and improve the quality of life.

The Relationship between FFMQ Mindfulness and Harmony in Life among Patients with Celiac Disease

Background

Patients with Celiac Disease (CD) experience psychological disorders and emotion-regulation disruptions. Although following a gluten-free diet alleviates their symptoms, these patients report social relationship problems.

Objective

The first aim of this study was to analyze the level of FFMQ mindfulness (describing emotions, acting with awareness, observing, non-judging of inner experience, and non-reactivity to inner experience) and harmony in life (HiL) in patients with CD. The second goal was to examine the relationship between the FFMQ and HiL scales in patients with CD. The third was to detect the effects of the duration of the illness, education level, and employment status on FFMQ-measured mindfulness and HiL.

Design

The study involved 111 Turkish patients with CD (N Females = 75, 67.6%) living in Turkey. The patients filled out the FFMQ and HiL questionnaires via a google form survey. The duration of their diagnosis, age, employment status, and education level were nominal variables. A Pearsons' correlation test, independent t-test, multiple linear regression, and one-way ANO VA were implemented.

Results

The results showed that patients with CD had a low level of HiL. The total FFMQ score was positively related to the HiL scale. Education and duration of diagnosis had a significant impact on the FFMQ and HiL scores. Age affected the level of describing emotions, and employment status had a strong effect on acting with awareness. However, gender affected neither the FFMQ nor HiL levels.

Conclusion

The results showed that patients with CD expressed a low level of HiL. Non-reactivity to inner experience, observing, and acting with awareness were positive predictors of the HiL scores. Moreover, since the HiL and FFMQ scales showed high internal consistency, the FFMQ and HiL questionnaires can be used in further studies of patients with CD.

Celiac disease in the COVID-19 pandemic

Background

The COVID-19 pandemic has had an impact on global health.

Design

The impact of the COVID-19 pandemic on patients with coeliac disease was assessed in the present review.

Results

The incidence of coeliac disease and the problems associated with coeliac disease increased during the COVID-19 pandemic. Adherence to the diet is crucial for the patient's health and quality of life since the only approved therapy for coeliac disease is a gluten withdrawal.

Conclusions

A gluten-free diet should be promoted by the therapeutic team and implemented among these categories of patients.

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Health education to follow the GFD does not exist in many countries. Unfortunately, the COVID-19 pandemic has increased psychological problems among patients with CD.

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The association of T1D with CD has been and remains a problem in CD management.

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Associating IBD with CD is again a challenge. Psychological problems also appeared in the associations of CD with T1D and IBD. The COVID-19 virus did not pose an increased risk to CD patients, but the COVID-19 pandemic brought many psychological problems to CD patients.

•

CD patients should adhere to GFD, in general, hence pay attention to gluten withdrawal during the COVID-19 pandemics, to avoid other complications and improve their QOL.

Effect of synbiotics and probiotics supplementation on autoimmune diseases: A systematic review and meta-analysis of clinical trials

BACKGROUND & AIMS

Today synbiotics are considered as immunomodulatory agents. The current systematic review and meta-analysis investigated the effect of synbiotics and probiotics on inflammatory and oxidative stress markers in autoimmune disease.

MATERIALS & METHODS

The English literature search was performed using PubMed, Scopus, Web of Science, and the Central Cochrane Library through March 2020. Random effects models and generic inverse variance methods were used to synthesize quantitative data by STATA₁₄.

RESULTS

From a total of 623 entries identified via searches, ten RCTs (n = 440; 216 as intervention, 224 as controls) were included. An additional eleven studies with same intervention and different markers were also explained systematically. The pooled effect size showed that Interleukin (IL)-6 (WMD = -7.79 pg/ml; 95% CI = -13.81, -1.77, P = 0.011), Tumor Necrosis Factor (TNF)-α (WMD = -1.05 pg/ml; 95% CI = -2.01, -0.10, P = 0.030), high sensitivity C-Reactive Protein (hs-CRP) (SMD = -0.58; 95% CI = -0.79, -0.37, P < 0.001), Malondialdehyde (MDA) (SMD = -0.36; 95% CI = -0.68, -0.04; P = 0.026), Homeostasis Model of Assessment-estimated Insulin Resistance (HOMA-IR) (WMD = -0.71; 95% CI = -1.05, -0.37, P < 0.001), and beta cell function (HOMA-β) (WMD = -15.18; 95% CI = -22.08, -8.28, P < 0.001) changed following probiotics (or synbiotics) supplementation. Also supplementation with doses more than 2 billion CFU could reduce IL-10 concentrations (WMD = -1.84; 95% CI = -2.23, 1.87; P < 0.001). Glutathione (GSH) and Total Antioxidant Capacity (TAC) levels did not influence by synbiotics and probiotics; insignificancy was remained after subgrouping for participants' age, study duration, and disease duration.

CONCLUSION

Our findings revealed that synbiotics and probiotics supplementation has significant effect on some inflammatory and oxidative stress markers; although, the number of trials was too small to powerful conclusion and further investigations may be needed.

An updated overview of spectrum of gluten-related disorders: clinical and diagnostic aspects

The incidence of gluten-related disorders (GRDs) continues to increase and its global prevalence is estimated at approximately 5% of the population. Celiac disease (CD), dermatitis herpetiformis (DH), gluten ataxia (GA), wheat allergy (WA), and non-celiac gluten sensitivity (NCGS) are the five major GRDs that present with a wide range of clinical manifestations. The diagnosis of GRDs can be challenging because the typical and atypical clinical manifestations of the GRDs overlap. In this review, the current definitions of gluten-related disorders, focusing on their clinical features, diagnostic and therapeutic approaches are presented. We concluded that GRDs are usually diagnosed using a combination of clinical features, serological tests, and histopathological findings. Treatment usually involves dietary modification.