Gluten-induced Neurocognitive Impairment: Results of a Nationwide Study.

GOALS: This study aimed to understand the neurocognitive symptoms associated with gluten exposure in individuals with self-reported celiac disease (CD) and nonceliac gluten sensitivity (NCGS). BACKGROUND: While gluten-induced neurocognitive impairment (GINI; eg, "celiac fog" or "brain fog") is commonly described by individuals with CD and NCGS, there are little data regarding the prevalence and symptoms associated with these experiences. STUDY: A 9-question online survey was accessed by 1396 individuals (1143 with CD; 253 with NCGS). Forced choice and free-response questions were asked of participants to obtain a description of neurocognitive symptoms experienced after gluten ingestion. Free-response answers were coded using a coding structure developed based on the Health-Related Quality of Life Instrument. RESULTS: The majority of survey participants (89% of CD and 95% of NCGS) reported having GINI symptoms. When describing symptoms, the most common word descriptors for both groups were difficulty concentrating, forgetfulness, and grogginess. Timing of symptoms, including onset and symptom peak, were similar across the 2 groups. Coding of free responses found the most common references were to cognitive, physical, psychological, and overall quality of life impacts. CONCLUSIONS: This survey suggests that GINI is common and may be severe in both individuals with CD and NCGS. Cognitive impairment and decline in physical functioning may be similar to that occurring in other illnesses, such as lupus. Clinical follow-up with both individuals with CD and NCGS should include assessment of GINI symptoms. Further research is warranted, including the development of a patient-reported outcome measure including neurocognitive effects of gluten exposure.

Attitudes to mesalamine questionnaire: a novel tool to predict mesalamine nonadherence in patients with IBD.

OBJECTIVES: Poor adherence to mesalamine is common and driven by a combination of lifestyle and behavioral factors, as well as health beliefs. We sought to develop a valid tool to identify barriers to patient adherence and predict those at risk for future nonadherence. METHODS: A 10-item survey was developed from patient-reported barriers to adherence. The survey was administered to 106 patients with ulcerative colitis who were prescribed mesalamine, and correlated with prospectively collected 12-month pharmacy refills (medication possession ratio (MPR)), urine levels of salicylates, and self-reported adherence (Morisky Medication Adherence Scale (MMAS)-8). RESULTS: From the initial 10-item survey, 8 items correlated highly with the MMAS-8 score at enrollment. Computer-generated randomization produced a derivation cohort of 60 subjects and a validation cohort of 46 subjects to assess the survey items in their ability to predict future adherence. Two items from the patient survey correlated with objective measures of long-term adherence: their belief in the importance of maintenance mesalamine even when in remission and their concerns about side effects. The additive score based on these two items correlated with 12-month MPR in both the derivation and validation cohorts (P<0.05). Scores on these two items were associated with a higher risk of being nonadherent over the subsequent 12 months (relative risk (RR) =2.2, 95% confidence interval=1.5-3.5, P=0.04). The area under the curve for the performance of this 2-item tool was greater than that of the 10-item MMAS-8 score for predicting MPR scores over 12 months (area under the curve 0.7 vs. 0.5). CONCLUSIONS: Patients' beliefs about the need for maintenance mesalamine and their concerns about side effects influence their adherence to mesalamine over time. These concerns could easily be raised in practice to identify patients at risk of nonadherence (Clinical Trial number NCT01349504).

Body image and Black African women: A comparative study of Kenya and Nigeria.

Very few cross-national studies on body image focus on Black African women. In this study, a comparative analytical approach and sociocultural theory framework was utilized in examining measures of body image among 209 Kenyan and Nigerian women aged 18-69 (M = 34.4, SD = 7.81). We examined both weight-related and non-weight-related aspects of appearance, including hair texture, skin tone, and other racialized features. The regional samples were compared on scores of internalized Eurocentric beauty ideals, skin color satisfaction, objectified body consciousness, racialized body image satisfaction, and other demographic metrics. Kenyan and Nigerian women showed differences across multiple body image measures. Nigerian women showed thinner body ideals compared to Kenyan women and also endorsed higher skin color satisfaction, racialized body dissatisfaction, and internalized Eurocentric beauty idealization. Kenyan women showed higher levels of objectified body consciousness. An indirect effect of nationality was observed with internalized Eurocentric beauty ideals mediating differences in racialized body dissatisfaction and objectified body shame. Attention to regional variation in appearance satisfaction may deepen understandings of the particular sociocultural influences impacting body image among populations of Black African women.

Risk Behavioral Contexts in Adolescence of Obese Adults.

PURPOSE: Previous research suggests that poor nutrition, physical activity, sleep, and social/emotional climate are associated with weight gain. However, few empirical studies have examined how these factors relate to each other in adolescents who are later obese. Are these factors uniformly present, or do some co-occur or occur independently? This study seeks to identify subgroups of obese individuals at ages 24-32 years who exhibited unique, co-occurring behavioral and emotional contexts for obesity at ages 14-17 years. METHODS: To identify subgroups of behavioral and contextual profiles in adolescence, the study applies latent class analysis to a sample of individuals who were obese in the fourth wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health, N = 1,889). The study then explored covariates (e.g., gender, race) of class membership. RESULTS: Considerable heterogeneity exists in risk profiles of adolescents obese as adults. For example, 21.1 percent of the sample is in a class with no differentiating risk factors, whereas two classes containing 22.1 percent of the sample exhibit high levels of depression, and nearly all the emotional factors are considered. Although some covariates are predictive of class membership, clear patterns are difficult to discern. However, poor physical health is clearly predictive of membership in the classes exhibiting a high risk of depression. DISCUSSION: Clinicians should be aware that at younger ages, people who are ultimately obese display a range of factors linked to obesity. Although some exhibit behaviors such as high screen time and processed food consumption, others exhibit mainly poor social/emotional climate.

A simple validated gluten-free diet adherence survey for adults with celiac disease.

BACKGROUND & AIMS: Celiac disease is an increasingly prevalent disorder. To monitor response to treatment in clinical and research settings, it is essential to accurately measure gluten-free diet (GFD) adherence in a standardized manner. The aim of this study was to develop a valid and reliable Celiac Dietary Adherence Test (CDAT). METHODS: Items and domains believed to be essential for successful GFD adherence were used to develop an 85-item survey with input from patient focus groups. The survey was administered to 200 individuals with biopsy-proven celiac disease who underwent standardized dietician evaluation (SDE) and serologic testing. RESULTS: Of the initial 85 items, 41 were correlated highly with the SDE (P < .01). Responses for all 200 participants for the 41 items were entered into a single database. Computer-generated randomization produced a derivation cohort of 120 subjects and a validation cohort of 80. By using the derivation cohort, a 7-item questionnaire was developed using logistic regression. The additive score based on these items was correlated highly with the SDE in both the derivation and validation cohorts (P < .001) and performed significantly better than immunoglobulin A tissue transglutaminase titers in receiver operating characteristic curve analysis with areas under the curve of 0.830 and 0.652, respectively. CONCLUSIONS: The CDAT is a clinically relevant, easily administered, 7-item instrument that allows for standardized evaluation of GFD adherence and is superior to tissue transglutaminase serology. The CDAT may be useful in both research and clinical settings.

Psychological correlates of gluten-free diet adherence in adults with celiac disease.

GOALS: To determine whether personality traits and psychological characteristics are related to gluten-free diet (GFD) adherence in an adult population diagnosed with celiac disease (CD). BACKGROUND: Little research has examined psychological correlates of adherence to the GFD. STUDY: One hundred fifty-seven adults with biopsy-confirmed CD on the GFD for >3 months completed measures of personality and self-reported GFD adherence, provided a blood sample, and participated in an evaluation of GFD adherence conducted by an expert dietician at a clinical care center in a major teaching hospital in Boston, MA. RESULTS: An expert evaluation of GFD adherence remained the "gold standard" for measuring GFD adherence when compared with self-report and serology. Logistic regression results indicated that the following were independently associated with GFD adherence: conscientiousness (B=-0.04, SE=0.01, P<0.00), values (B=-0.10, SE=0.05, P<0.05), other food intolerances [odds ratio=0.28, 95% confidence interval=0.10-0.78], and CD symptoms (B=0.05, SE=0.02, P<0.03). A model accounting for these associations effectively predicted whether a participant was adherent or nonadherent on the basis of psychological and demographic/disease-specific factors. Successful prediction rates of GFD adherence for the final model were 75.8% for those rated to be adherent with the GFD and 54.5% for those rated to be nonadherent with the GFD. CONCLUSIONS: The model of psychological and demographic/disease-specific characteristics developed can be used to identify patients who may be at risk for poor dietary adherence to provide additional support, education, and encouragement to individuals with CD.

The interaction between eating disorders and celiac disease: an exploration of 10 cases.

Celiac disease is an inflammatory disorder in which certain peptides from wheat and related grains trigger and maintain an immune reaction in the small intestine. Anorexia nervosa and bulimia nervosa are eating disorders that are morbid and, at times, life-threatening forms of psychopathology. Despite a large body of evidence describing the detrimental effects of eating disorders on the gastrointestinal system, information on the role of the gastrointestinal system in causing or mimicking eating disorders is scarce. To date, eating disorders, as a comorbid condition affecting individuals with celiac disease, has received surprisingly little attention with only a single report found in peer-reviewed literature. In this report, we describe a series of 10 individuals with both celiac disease and eating disorders. These cases demonstrate the complex ways in which celiac disease and eating disorders interact with important clinical implications for the diagnosis and treatment of both illnesses. Our findings suggest that clinicians treating patients with eating disorders or celiac disease should be aware of both conditions to provide optimum care.