The only known treatment for celiac disease (CeD), a common autoimmune disease, is a gluten-free (GF) diet – where strict adherence has been associated with improved quality of life (QOL).
To determine whether diet quality or ultra-processed food (UPF) consumption was associated with QOL in National Health and Nutrition Examination Survey (NHANES) and in a sample with CeD.
Study Design, Settings, Participants
A cross-sectional analysis of a sample of 50 adults (84% F) and 30 teens (80 % F) with CeD from a regional CeD-Center in a Northeastern American city was compared with three 2-year cycles (2009-14) of NHANES, 15,853 adults (51% F) and 2,304 teens (52% F), including individuals with CeD.
Diet quality using Alternate Mediterranean Diet (AMED) and level of UPF (% energy) using the NOVA classification system, were assessed using multiple 24-h diet recalls. All foods, even GF, were categorized. QOL was measured using 5 components of the CeD-specific QOL survey (CDQOL) – adult sample with CeD, the CeD-specific Pediatric – QOL (CDPQOL) – teen sample with CeD, and a general health-related QOL (HRQOL) survey - NHANES. Associations between diet quality and QOL were examined using ordinal logistic regression for the NHANES data, and ANCOVA for the smaller sample (P < 0.05).
In NHANES, being in the highest versus lowest of 3 AMED categories, or lowest versus highest quintiles of UPF consumption, were ∼2x more likely to have higher QOL, explaining ∼8-10% of variance. Among the smaller teens sample with CeD, those in the highest versus lowest AMED tertile were more likely to have higher QOL, but no association was found in adults. Additionally, for all in the smaller sample with CeD, those in the lowest versus highest tertile of UPF were more likely to have higher QOL (some components). All P < 0.05.
Higher adherence to AMED and lower UPF consumption were associated with higher QOL in NHANES and less robustly in a smaller sample with CeD.