Previous case reports have suggested an association between coeliac disease (CD) with anorexia nervosa (AN), but there have been few large-scale studies on the subject. Now a new study of 18,000 women with CD has demonstrated a positive association between CD and AN, both before and after CD diagnosis.
It found patients diagnosed with CD before age 19 were 4.5 times more likely to have previously been diagnosed with AN, while adults previously diagnosed with CD had double the rate of subsequently developing AN.
The authors suggest a number of factors may contribute to the association including the fact that individuals with underlying CD or AN may be misdiagnosed with the other condition. Writing in Pediatrics , they say: “In patients who receive an initial erroneous CD diagnosis, it should soon become evident that the gluten-free diet is not effective and additional evaluation would reveal the eating disorder. In patients who receive an initial erroneous diagnosis of AN and who present with ongoing symptoms of fatigue and abdominal complaints, additional workups should be initiated to rule out CD or other gastrointestinal illnesses.”
The authors add that surveillance bias and genetic susceptibility may also play a role in the association.