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Celiac Disease and Anorexia Nervosa: A Nationwide Study
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Barbara Davis Center, University of Colorado, Aurora CO, United States.
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Pediatrics, Ostfold Hospital Trust, Gralum, Norway.
Department of Medical Epidemiology and Biostatistics, Norway; Departments of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, United States; Departments of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill NC, United States.
Barbara Davis Center, University of Colorado, Aurora CO, United States.
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2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 5, e20164367Article in journal (Refereed) Published
Abstract [en]

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 (vinous 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 A, confidence interval [Cl], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% Cl, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% Cl, 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.

Place, publisher, year, edition, pages
American Academy of Pediatrics , 2017. Vol. 139, no 5, e20164367
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:oru:diva-57866DOI: 10.1542/peds.2016-4367ISI: 000400371500048Scopus ID: 2-s2.0-85019017417OAI: oai:DiVA.org:oru-57866DiVA: diva2:1103982
Funder
Swedish Research Council, 558-2015-8864
Note

Funding Agency:

OAK foundation, Geneva, Switzerland

Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-10-05Bibliographically approved

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Citation style
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