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
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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DOI：
10.1111/jhn.12638
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发表时间：
2019-06-01
影响因子：
3.3
通讯作者：
Green, P. H. R.
中科院分区：
文献类型：
--
作者：
Cadenhead, J. W.;Wolf, R. L.;Green, P. H. R.
背景某些管理乳糜泻（CD）的严格无麸质饮食（GFD）的方法可能会导致心理社会健康受损，生活质量（QOL）下降和饮食紊乱。本研究旨在了解青少年管理GFD的方法及其与QOL的关联。方法对30例GFD后1年以上的13-17岁CD青少年进行了腹腔饮食依从性试验（CDAT）和生活质量调查。他们的GFD管理方法进行了探讨，使用半结构化访谈，其中的关键主题开发使用迭代过程，并进一步分析使用社会心理学的标题分类管理策略和生活质量。比较各组的CDAT评分。结果无麸质饮食管理策略分为四点规模。适应性饮食行为的特点是更大的灵活性（相对于刚性），信任（相对于回避），信心（相对于控制行为）和意识（相对于专注），以保持GFD。大约一半的样本（53.3%）表达了更多的不适应方法来维持GFD，并且这样做的人年龄较大，CD特异性儿科生活质量（CDPQOL）评分较低，平均子量表差异范围为15.0分（t = 2.4，P = 0.03，d.f.）。= 28）至23.4分（t = 3.0，P = 0.01，d. f. = 28）。结论：患有CD的青少年，其GFD与适应不良的饮食行为类似于已知的进食障碍和进食障碍的危险因素，其生活质量下降。根据CD管理建议，我们建议根据需要与胃肠病学家和营养师以及心理社会支持转诊进行持续随访。
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.