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<p>Lifelong adherence to a strict gluten-free diet (GFD) remains the only effective therapy for celiac disease (CD). Nevertheless, several factors may interfere with strict adherence. This study aimed to investigate whether food insecurity and eating attitudes are associated with adherence to a GFD, as well as their impact on clinical symptoms and quality of life (QoL) in adults with CD. In this cross-sectional study, 172 adults with CD from Fars Province, Iran, were enrolled from the Fars Province Celiac Disease Registry to examine the associations between food insecurity and eating attitudes with adherence to a GFD, clinical symptoms, QoL, and Body Mass Index (BMI). Food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), and eating attitudes were evaluated using the Eating Attitudes Test-26 (EAT-26). Adherence to the GFD was measured using both the Celiac Disease Adherence Test (CDAT) and the Biagi tool, while clinical symptom severity was assessed using a Visual Analog Scale (VAS), and QoL was evaluated using the Celiac Disease Quality of Life (CD-QOL) questionnaire. Compared with food-secure individuals, those with severe food insecurity had significantly higher symptom severity scores (β = 22.48, <i>P</i> &lt; 0.001) and poorer QoL (β = 22.91, <i>P</i> &lt; 0.001). They also had lower odds of good adherence to a GFD according to both the CDAT (OR = 0.05, 95% CI: 0.02–0.14, <i>P</i> &lt; 0.001) and the Biagi tool (OR = 0.14, 95% CI: 0.05–0.38, <i>P</i> &lt; 0.001). Similarly, participants with disordered eating attitudes had higher symptom severity scores (β = 17.20, <i>P</i> &lt; 0.001), poorer QoL (β = 11.49, <i>P</i> = 0.001), and lower odds of good GFD adherence according to the CDAT (OR = 0.46, 95% CI: 0.24–0.87, <i>P</i> = 0.016) and the Biagi tool (OR = 0.36, 95% CI: 0.18–0.74, <i>P</i> = 0.005). No significant associations were observed between BMI and either food insecurity or eating attitudes. The results indicated significant associations between food insecurity and disordered eating attitudes with more severe clinical symptoms, lower QoL and reduced adherence to a GFD. These insights highlight the importance of addressing these factors in clinical settings to improve patient outcomes.</p>

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The relationship of eating attitudes and food insecurity with health outcomes in adults with celiac disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • Andisheh Khoshrang,
  • Sahar Foshati,
  • Ramin Niknam,
  • Naser Honar,
  • Ebrahim Fallahzadeh Abarghooei,
  • Siavash Babajafari

摘要

Lifelong adherence to a strict gluten-free diet (GFD) remains the only effective therapy for celiac disease (CD). Nevertheless, several factors may interfere with strict adherence. This study aimed to investigate whether food insecurity and eating attitudes are associated with adherence to a GFD, as well as their impact on clinical symptoms and quality of life (QoL) in adults with CD. In this cross-sectional study, 172 adults with CD from Fars Province, Iran, were enrolled from the Fars Province Celiac Disease Registry to examine the associations between food insecurity and eating attitudes with adherence to a GFD, clinical symptoms, QoL, and Body Mass Index (BMI). Food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), and eating attitudes were evaluated using the Eating Attitudes Test-26 (EAT-26). Adherence to the GFD was measured using both the Celiac Disease Adherence Test (CDAT) and the Biagi tool, while clinical symptom severity was assessed using a Visual Analog Scale (VAS), and QoL was evaluated using the Celiac Disease Quality of Life (CD-QOL) questionnaire. Compared with food-secure individuals, those with severe food insecurity had significantly higher symptom severity scores (β = 22.48, P < 0.001) and poorer QoL (β = 22.91, P < 0.001). They also had lower odds of good adherence to a GFD according to both the CDAT (OR = 0.05, 95% CI: 0.02–0.14, P < 0.001) and the Biagi tool (OR = 0.14, 95% CI: 0.05–0.38, P < 0.001). Similarly, participants with disordered eating attitudes had higher symptom severity scores (β = 17.20, P < 0.001), poorer QoL (β = 11.49, P = 0.001), and lower odds of good GFD adherence according to the CDAT (OR = 0.46, 95% CI: 0.24–0.87, P = 0.016) and the Biagi tool (OR = 0.36, 95% CI: 0.18–0.74, P = 0.005). No significant associations were observed between BMI and either food insecurity or eating attitudes. The results indicated significant associations between food insecurity and disordered eating attitudes with more severe clinical symptoms, lower QoL and reduced adherence to a GFD. These insights highlight the importance of addressing these factors in clinical settings to improve patient outcomes.