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Cited by 76Celiac Disease Research and ManagementChild Nutrition and Feeding IssuesEating Disorders and Behaviors

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

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Cadenhead, J. W., Wolf, R. L., Lebwohl, B., Lee, A. R., Zybert, P., Reilly, N. R., Schebendach, J., Satherley, R. +1 more·2019·Journal of Human Nutrition and Dietetics
DOI 10.1111/jhn.12638PMC PMC6467807
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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.

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Cited by

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Authors
Cadenhead, J. W., Wolf, R. L., Lebwohl, B., Lee, A. R., Zybert, P., Reilly, N. R., Schebendach, J., Satherley, R., & Green, P. H. R.
Affiliations
  • Columbia University (US)
  • Columbia University Irving Medical Center (US)
  • King's College London (GB)
Corresponding author
Cadenhead, J. W.
ORCID
Venue
Journal of Human Nutrition and Dietetics
Publisher
Wiley
Published
2019-03-05
Volume
32
Issue
3
Pages
311-320
ISSN
  • 0952-3871 (ISSN-L)
  • 1365-277X
DOI
10.1111/jhn.12638
PMC
PMC6467807
OpenAlex
W2919331625
Cited by
76
References
2
Citations by year
2026: 14 · 2025: 13 · 2024: 14 · 2023: 7 · 2022: 11 · 2021: 8 · 2020: 7 · 2019: 2
FWCI
6.38
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Human Nutrition and Dietetics (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • Columbia University
  • National Center for Advancing Translational Sciences (UL1 TR000040)
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
celiac disease, adolescents, gluten-free diet, quality of life, dietary adherence, disordered eating, psychosocial well-being, eating disorder risk
MeSH terms
Adaptation, Psychological, Adolescent, Feeding and Eating Disorders, Celiac Disease, Cross-Sectional Studies, Feeding Behavior, Female, Humans, Male, Patient Compliance, Quality of Life, Surveys and Questionnaires, Risk Factors, Qualitative Research, Diet, Gluten-Free

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