Does Gluten Avoidance in Patients with Celiac Disease Increase the Risk of Developing Eating Disorders?
Does Gluten Avoidance in Patients with Celiac Disease Increase the Risk of Developing Eating Disorders?
复制标题
乳糜泻患者避免麸质是否会增加饮食失调的风险？
DOI：
10.1007/s10620-023-07915-3
复制
发表时间：
2023
影响因子：
3.1
通讯作者：
BurtonMurray,Helen
中科院分区：
文献类型：
--
作者：
Abber,SophieR;BurtonMurray,Helen
进食障碍是严重的精神健康障碍，以异常的进食行为为典型，有时与身体形象障碍有关。随着病情的发展，饮食失调可能会对身体健康和心理社会功能产生负面影响。进食障碍的早期识别是必不可少的，因为行为，营养和药物治疗的机构可以减轻一些最可怕的后果[PMID：32171414]。进食障碍可以与依赖于特定饮食调整的许多胃肠疾病共存。一个例子是乳糜泻（CD），它需要食用无麸质饮食（GFD）[1]。越来越多的文献表明，严格遵守GFD可能会影响心理健康和生活质量，并担心一些患者可能会出现饮食失调。进食障碍与CD之间存在高度相关性，根据最近的一项系统性综述和荟萃分析[2]，CD患者中进食障碍的合并患病率为8.88%，进食障碍患者中CD的合并患病率为0.90%。事实上，该荟萃分析还显示了神经性厌食症和CD之间的双向风险，CD中神经性厌食症的相对风险为1.48，CD中神经性厌食症的相对风险为2.35 [2]。然而，为什么CD和饮食失调相关尚未确定。在本期《消化系统疾病与科学》中，Gholmie et al. [3]评估腹腔疾病食物态度和行为（CD-FAB）量表[4]在确定50名成人CD患者对食物的适应不良态度和行为方面的效用。Gholmie等人[5]这两个（1）与开始GFD后体重增加相关的痛苦和（2）围绕谷蛋白交叉污染可能性的焦虑增加可能有助于CD患者饮食失调症状的发展。例如，由于GFD而体重增加的CD患者可能会经历更大的身体形象问题，并因此参与适应不良的体重控制行为（例如，自我诱发的呕吐，过度的饮食限制）。或者，CD患者可能会非常担心麸质交叉污染的可能性，以至于他们避免其他不含麸质的食物，从而跨越门槛进入非身体形象饮食障碍，称为回避/限制性食物摄入障碍（ARFID）。虽然尚未评价CD-FAB与进食障碍风险或当前进食障碍症状严重程度的关系，但Gholmie等人采取了关键的下一步措施，以了解CD-FAB与CD成人临床特征之间的关系。CD-FAB有三个分量表，评估适应不良的食物态度和行为，项目反映了面筋污染周围焦虑的不同方面。Gholmie等人[3]发现CDFAB得分最高的三分位数的个体最近被诊断患有CD，具有更多的CD相关胃肠道疾病，并且具有降低的CD特异性生活质量。有趣的是，由于样本中CDFAB项目的平均总分和平均得分范围均低于或接近量表中点，因此确定表明适应不良食物态度/行为的阈值将是有益的。对麸质暴露的谨慎和一些焦虑，特别是在适应新的诊断时，是正常的，尽管尚不清楚谨慎在什么时候会变成病理性的。Coburn和他的同事最近提出了一个模型，其中当一个人对生活质量高度警惕时，量表会倾向于过度谨慎。
Eating disorders are serious mental health disorders typified by abnormal eating behaviors, sometimes associated with body image disturbance. As they progress, eating disorders may negatively affect physical health and psychosocial functioning. Early identification of eating disorders is essential since the institution of behavioral, nutritional, and pharmacologic therapy can lessen some their most dire consequences [PMID: 32171414]. Eating disorders can coexist with many gastroenterological conditions the rely on specific dietary modifications. One example is celiac disease (CD), which requires the consumption of a gluten-free diet (GFD)[1]. A growing body of literature suggests that strict adherence to a GFD may impact psychological health and quality-of-life, with the concern that some patients may develop disordered eating. There is high correlation between eating disorders and CD, with the pooled prevalence of an eating disorder in individuals with CD at 8.88% and the pooled prevalence of CD at 0.90% in individuals with an eating disorder, according to a recent systematic review and meta-analysis [2]. In fact, this metaanalysis also shows a bi-directional risk between anorexia nervosa and CD with a relative risk of anorexia nervosa in CD of 1.48 and a relative risk of CD in anorexia nervosa of 2.35 [2]. Nevertheless, why CD and eating disorders are related has yet to be determined. In this issue of Digestive Diseases and Sciences, Gholmie et al.[3] assess the utility of the Celiac Disease FoodAttitudes and Behaviors (CD-FAB) scale [4] in identifying maladaptive attitudes and behaviors toward food in a sample of 50 adults with CD. Gholmie et al.[5] posit that both (1) distress related to weight gain after beginning a GFD and (2) increased anxiety surrounding the possibility of gluten cross-contamination could contribute to the development of eating disorder symptoms in individuals with CD. For example, individuals with CD gaining weight as a result of a GFD may experience greater body image concerns, and as a result engage in maladaptive weight control behaviors (eg, self-induced vomiting, excessive dietary restrictions). Alternatively, individuals with CD may become exceedingly worried about the possibility of gluten cross-contamination to the extent that they avoid other non-gluten-containing foods, crossing the threshold into a non-body image-based eating disorder termed avoidant/restrictive food intake disorder (ARFID). Whereas the CD-FAB has not yet been evaluated in relation to eating disorder risk or current eating disorder symptom severity, Gholmie et al. take a key next step to understand the relationship between the CD-FAB and clinical characteristics in adults with CD. The CD-FAB has three subscales assessing maladaptive food attitudes and behaviors with items reflective of different facets of anxiety around gluten contamination. Gholmie et al.[3] found that individuals in the highest tertile of CDFAB scores were recently diagnosed with CD, had a larger number of CD-related gastrointestinal complaints, and had a reduced CD-specific quality-of-life. Interestingly, since both the average total scores and the range of mean scores of CDFAB items in their sample were below or around the scale midpoint, it would be informative to identify thresholds that indicate maladaptive food attitudes/behaviors. Caution of and some anxiety around gluten exposure, particularly while adjusting to a new diagnosis are normative, though it is unknown at what point caution becomes pathologic. Coburn and colleagues recently suggested a model in which the scale is tipped to over-caution when an individual is hypervigilant with greater quality-of-life …
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DOI：
10.1016/j.gastha.2022.01.002
发表时间：
2022-01-01
期刊：
Gastro hep advances
影响因子：
--
作者：
Bennett, Audrey;Bery, Alexandra;Adams, Dawn W
通讯作者：
Adams, Dawn W
影响因子：
12.6
作者：
Murray, Helen Burton;Bailey, Abbey P.;Kuo, Braden
通讯作者：
Kuo, Braden
患者行为何时表明回避性限制性食物摄入障碍 (ARFID) 与对消化系统疾病的合理反应？
影响因子：
12.6
作者：
M. Fink;M. Simons;K. Tomasino;Anjali Pandit;T. Taft
通讯作者：
T. Taft
影响因子：
3.1
作者：
Gholmie, Yara;Lee, Anne R.;Satherley, Rose-Marie;Schebendach, Janet;Zybert, Patricia;Green, Peter H. R.;Lebwohl, Benjamin;Wolf, Randi
通讯作者：
Wolf, Randi