Hypervigilance to a Gluten-Free Diet and Decreased Quality of Life in Teenagers and Adults with Celiac Disease
Hypervigilance to a Gluten-Free Diet and Decreased Quality of Life in Teenagers and Adults with Celiac Disease
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DOI：
10.1007/s10620-018-4936-4
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发表时间：
2018-06-01
影响因子：
3.1
通讯作者：
Green, Peter H. R.
中科院分区：
文献类型：
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作者：
Wolf, Randi L.;Lebwohl, Benjamin;Green, Peter H. R.
背景和目的避免面筋对乳糜泻(CD)患者至关重要，但也有人担心，对严格的无面筋饮食保持极端警惕可能会增加焦虑和疲劳等症状，从而降低生活质量(QOL)。我们研究了生活质量与能量水平、对无麸质饮食的坚持和了解的关系。方法这是一项横断面前瞻性研究，研究对象为80名青少年和成年人，他们都患有经活检证实的CD，生活在一个主要的大都市地区。采用CD特异量表进行生活质量评估。饮食警戒是基于24小时回忆和一次采访。这些知识是基于一项食品标签测试。开放式问题描述了保持无面筋饮食的促进者和障碍。结果在我们的样本中，极度警惕的成年人的生活质量得分显著低于那些不那么警惕的成年人[平均(SD)：64.2vs77.2vs77.212.2，p=0.004]。极度警觉也与更多的知识相关[5.7vs5.1(0.8p=0.035)]。能量水平较低的成年人的总体生活质量得分显著低于能量水平较高的成年人[68.0vs78.913.0，p=0.006]。青少年的情况也类似。在家做饭以及使用互联网网站和应用程序是高度警惕的人为保持严格的无麸质饮食而使用的普遍策略。外出就餐尤其成问题。结论过度警惕严格的无麸质饮食有潜在的负面后果。临床医生必须考虑同时促进CD患者饮食依从性以及社会和情感健康的重要性。
Background and Aims Avoidance of gluten is critical for individuals with celiac disease (CD), but there is also concern that "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). We examined the associations of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet.Methods This is a cross-sectional prospective study of 80 teenagers and adults, all with biopsy-confirmed CD, living in a major metropolitan area. QOL was assessed with CD-specific measures. Dietary vigilance was based on 24-h recalls and an interview. Knowledge was based on a food label quiz. Open-ended questions described facilitators and barriers to maintaining a gluten-free diet.Results The extremely vigilant adults in our sample had significantly lower QOL scores than their less vigilant counterparts [(mean (SD): 64.2 (16.0) vs 77.2 (12.2), p = 0.004]. Extreme vigilance was also associated with greater knowledge [5.7 (0.7) vs 5.1 (0.8), p = 0.035]. Adults with lower energy levels had significantly lower overall QOL scores than adults with higher energy levels [68.0 (13.6) vs 78.9 (13.0), p = 0.006]. Patterns were similar for teenagers. Cooking at home and using internet sites and apps were prevalent strategies used by the hypervigilant to maintain a strict gluten-free diet. Eating out was particularly problematic.Conclusion There are potential negative consequences of hypervigilance to a strict gluten-free diet. Clinicians must consider the importance of concurrently promoting both dietary adherence and social and emotional well-being for individuals with CD.