Karl Mårild1,2, Ketil Størdal3,4, Cynthia M Bulik5,6,7, Marian Rewers2, Anders Ekbom8, Edwin Liu2, Jonas F Ludvigsson5,9,10,11. 1. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; karlmarild@gmail.com. 2. Barbara Davis Center, University of Colorado, Aurora, Colorado. 3. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. 4. Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway. 5. Department of Medical Epidemiology and Biostatistics and. 6. Departments of Psychiatry and. 7. Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 8. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 9. Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden. 10. Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and. 11. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
Abstract
BACKGROUND AND OBJECTIVE: Previous research suggests an association of celiac disease (CD) with anorexia nervosa (AN), but data are mostly limited to case reports. We aimed to determine whether CD is associated with the diagnosis of AN. METHODS: Register-based cohort and case-control study including women with CD (n = 17 959) and sex- and age-matched population-based controls (n = 89 379). CD (villous atrophy) was identified through the histopathology records of Sweden's 28 pathology departments. Inpatient and hospital-based outpatient records were used to identify AN. Hazard ratios for incident AN diagnosis were estimated by using stratified Cox regression with CD diagnosis as a time-dependent exposure variable. In the secondary analyses, we used conditional logistic regression to estimate odds ratios for being diagnosed with AN before CD. RESULTS: Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45-3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes. CONCLUSIONS: The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity.
BACKGROUND AND OBJECTIVE: Previous research suggests an association of celiac disease (CD) with anorexia nervosa (AN), but data are mostly limited to case reports. We aimed to determine whether CD is associated with the diagnosis of AN. METHODS: Register-based cohort and case-control study including women with CD (n = 17 959) and sex- and age-matched population-based controls (n = 89 379). CD (villous atrophy) was identified through the histopathology records of Sweden's 28 pathology departments. Inpatient and hospital-based outpatient records were used to identify AN. Hazard ratios for incident AN diagnosis were estimated by using stratified Cox regression with CD diagnosis as a time-dependent exposure variable. In the secondary analyses, we used conditional logistic regression to estimate odds ratios for being diagnosed with AN before CD. RESULTS: Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45-3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes. CONCLUSIONS: The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity.
Authors: Laura Kivelä; Alberto Caminero; Daniel A Leffler; Maria Ines Pinto-Sanchez; Jason A Tye-Din; Katri Lindfors Journal: Nat Rev Gastroenterol Hepatol Date: 2020-11-20 Impact factor: 46.802
Authors: J W Cadenhead; R L Wolf; B Lebwohl; A R Lee; P Zybert; N R Reilly; J Schebendach; R Satherley; P H R Green Journal: J Hum Nutr Diet Date: 2019-03-05 Impact factor: 3.089
Authors: Imke Reese; Christiane Schäfer; Jörg Kleine-Tebbe; Birgit Ahrens; Oliver Bachmann; Barbara Ballmer-Weber; Kirsten Beyer; Stephan C Bischoff; Katharina Blümchen; Sabine Dölle; Paul Enck; Axel Enninger; Isidor Huttegger; Sonja Lämmel; Lars Lange; Ute Lepp; Vera Mahler; Hubert Mönnikes; Johann Ockenga; Barbara Otto; Sabine Schnadt; Zsolt Szepfalusi; Regina Treudler; Anja Wassmann-Otto; Torsten Zuberbier; Thomas Werfel; Margitta Worm Journal: Allergo J Int Date: 2018-05-28