Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Health-related quality of life is not impaired in children with undetected as well as diagnosed celiac disease: a large population based cross-sectional study

Authors: Anna Myléus, Solveig Petersen, Annelie Carlsson, Solveig Hammarroth, Lotta Högberg, Anneli Ivarsson

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

Knowledge regarding the health-related quality of life (HRQoL) of children with celiac disease remains limited and inconclusive. We investigated the HRQoL of three groups of 12-year-olds with: i) undetected celiac disease ii) clinically diagnosed celiac disease, and iii) without celiac disease.

Methods

A school-based cross-sectional multicenter screening study invited 18 325 children, whereof 68% consented to participate. Participants provided a blood sample, which was later analyzed for anti-tissue-tranglutaminase antibodies, and alongside filled in a questionnaire. When anti-tissue-tranglutaminase antibodies were elevated, a small intestinal biopsy verified the screening-detected celiac disease diagnosis. Self-reported HRQoL was measured using Kidscreen, a generic 52 items instrument with proven reliability and validity. Scores were linearly transformed into a 0–100 scale with higher values indicating better HRQoL. Mean values with standard deviations (mean ± SD) were compared, and uni- and multivariate logistic regression models tested the odds of a low HRQoL among children with undetected or diagnosed celiac disease, respectively.

Results

Children with undetected celiac disease (n = 238) reported similar HRQoL as children without celiac disease (n = 12 037) (83.0 ± 11.0 vs. 82.5 ± 11.3, P = 0.51), and also similar HRQoL (82.2 ± 12.2, P = 0.28) to that of children with diagnosed celiac disease (n = 90), of whom 92% were adherent to treatment. Having undetected celiac disease did not increase the odds of low overall HRQoL, independent of sex, area of residence, study year and occurrence of gastrointestinal symptoms (adjusted odds ratio 0.77, 95% CI 0.54-1.10). Comparable results were seen for diagnosed celiac disease cases (adjusted odds ratio 1.11, 95% CI 0.67-1.85).

Conclusion

Children with undetected celiac disease reported comparable HRQoL as their peers with diagnosed celiac disease, and those without celiac disease, when reporting prior to receiving the diagnosis through screening. Thus, children with celiac disease, both untreated and diagnosed, perceive their HRQoL as unimpaired by their disease.
Appendix
Available only for authorised users
Literature
1.
Green PH, Cellier C: Celiac disease. N Engl J Med. 2007, 357 (17): 1731-1743. 10.1056/NEJMra071600.CrossRefPubMed
2.
Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, Hadjivassiliou M, Kaukinen K, Kelly CP, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C: The Oslo definitions for coeliac disease and related terms. Gut. 2013, 62 (1): 43-52. 10.1136/gutjnl-2011-301346.CrossRefPubMed
3.
di Sabatino A, Corazza GR: Coeliac disease. Lancet. 2009, 373 (9673): 1480-1493. 10.1016/S0140-6736(09)60254-3.CrossRefPubMed
4.
Lionetti E, Catassi C: New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. Int Rev Immunol. 2011, 30 (4): 219-231. 10.3109/08830185.2011.602443.CrossRefPubMed
5.
Zawahir S, Safta A, Fasano A: Pediatric celiac disease. Curr Opin Pediatr. 2009, 21 (5): 655-660. 10.1097/MOP.0b013e32832f5b9d.CrossRefPubMed
6.
Tio M, Cox MR, Eslick GD: Meta-analysis: coeliac disease and the risk of all-cause mortality, any malignancy and lymphoid malignancy. Aliment Pharmacol Ther. 2012, 35 (5): 540-551. 10.1111/j.1365-2036.2011.04972.x.CrossRefPubMed
7.
Ludvigsson JF: Mortality and malignancy in celiac disease. Gastrointest Endosc Clin N Am. 2012, 22 (4): 705-722. 10.1016/j.giec.2012.07.005.CrossRefPubMed
8.
Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Maki M, Ribes-Koninckx C, Ventura A, Zimmer KP, Espghan Working Group on Coeliac Disease Diagnosis, Espghan Gastroenterology Committee, European Society for Pediatric Gastroenterology, Hepatology and Nutrition: European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012, 54 (1): 136-160. 10.1097/MPG.0b013e31821a23d0.CrossRefPubMed
9.
Rizkalla Reilly N, Dixit R, Simpson S, Green PH: Celiac disease in children: an old disease with new features. Minerva Pediatr. 2012, 64 (1): 71-81.PubMed
10.
Lee AR, Ng DL, Zivin J, Green PH: Economic burden of a gluten-free diet. J Hum Nutr Diet. 2007, 20 (5): 423-430. 10.1111/j.1365-277X.2007.00763.x.CrossRefPubMed
11.
Black JL, Orfila C: Impact of coeliac disease on dietary habits and quality of life. J Hum Nutr Diet. 2011, 24 (6): 582-587. 10.1111/j.1365-277X.2011.01170.x.CrossRefPubMed
12.
Olsson C, Lyon P, Hornell A, Ivarsson A, Sydner YM: Food that makes you different: the stigma experienced by adolescents with celiac disease. Qual Health Res. 2009, 19 (7): 976-984. 10.1177/1049732309338722.CrossRefPubMed
13.
Rosen A, Ivarsson A, Nordyke K, Karlsson E, Carlsson A, Danielsson L, Hogberg L, Emmelin M: Balancing health benefits and social sacrifices: a qualitative study of how screening-detected celiac disease impacts adolescents’ quality of life. BMC Pediatr. 2011, 11: 32-10.1186/1471-2431-11-32.CrossRefPubMedPubMedCentral
14.
Aggarwal S, Lebwohl B, Green PH: Screening for celiac disease in average-risk and high-risk populations. Ther Adv Gastroenterol. 2012, 5 (1): 37-47. 10.1177/1756283X11417038.CrossRef
15.
Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V, Pan I, Macneil J, Mack D, Patel D, Moher D: The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005, 128 (4 Suppl 1): S57-67.CrossRefPubMed
16.
Myleus A, Ivarsson A, Webb C, Danielsson L, Hernell O, Hogberg L, Karlsson E, Lagerqvist C, Norstrom F, Rosen A, Sandstrom O, Stenhammar L, Stenlund H, Wall S, Carlsson A: Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic. J Pediatr Gastroenterol Nutr. 2009, 49 (2): 170-176. 10.1097/MPG.0b013e31818c52cc.CrossRefPubMed
17.
Mearin ML, Ivarsson A, Dickey W: Coeliac disease: is it time for mass screening?. Best Pract Res Clin Gastroenterol. 2005, 19 (3): 441-452. 10.1016/j.bpg.2005.02.004.CrossRefPubMed
18.
Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD: Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics. 2005, 116 (6): e754-e759. 10.1542/peds.2005-0904.CrossRefPubMed
19.
Testa MA, Simonson DC: Assesment of quality-of-life outcomes. N Engl J Med. 1996, 334 (13): 835-840. 10.1056/NEJM199603283341306.CrossRefPubMed
20.
The Kidscreen Group Europe: The KIDSCREEN Questionnaires, Quality of life questionnaires for children and adolescents. Handbook. 2006, Lengerich: Pabst Science Publishers
21.
Ravens-Sieberer U, Herdman M, Devine J, Otto C, Bullinger M, Rose M, Klasen F: The European KIDSCREEN approach to measure quality of life and well-being in children: development, current application, and future advances. Qual Life Res. 2014, 23 (3): 791-803. 10.1007/s11136-013-0428-3.CrossRefPubMed
22.
Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, Auquier P, Power M, Abel T, Czemy L, Mazur J, Czimbalmos A, Tountas Y, Hagquist C, Kilroe J, Kidscreen Group E: KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res. 2005, 5 (3): 353-364. 10.1586/14737167.5.3.353.CrossRefPubMed
23.
Kurppa K, Collin P, Maki M, Kaukinen K: Celiac disease and health-related quality of life. Expert Rev Gastroenterol Hepatol. 2011, 5 (1): 83-90. 10.1586/egh.10.81.CrossRefPubMed
24.
Ukkola A, Maki M, Kurppa K, Collin P, Huhtala H, Kekkonen L, Kaukinen K: Diet improves perception of health and well-being in symptomatic, but not asymptomatic, patients with celiac disease. Clin Gastroenterol Hepatol. 2011, 9 (2): 118-123. 10.1016/j.cgh.2010.10.011.CrossRefPubMed
25.
Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M: Gluten-free diet and quality of life in patients with screen-detected celiac disease. Eff Clin Pract. 2002, 5 (3): 105-113.PubMed
26.
Johnston SD, Rodgers C, Watson RG: Quality of life in screen-detected and typical coeliac disease and the effect of excluding dietary gluten. Eur J Gastroenterol Hepatol. 2004, 16 (12): 1281-1286. 10.1097/00042737-200412000-00008.CrossRefPubMed
27.
Viljamaa M, Collin P, Huhtala H, Sievanen H, Maki M, Kaukinen K: Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther. 2005, 22 (4): 317-324. 10.1111/j.1365-2036.2005.02574.x.CrossRefPubMed
28.
Kinos S, Kurppa K, Ukkola A, Collin P, Lahdeaho ML, Huhtala H, Kekkonen L, Maki M, Kaukinen K: Burden of illness in screen-detected children with celiac disease and their families. J Pediatr Gastroenterol Nutr. 2012, 55 (4): 412-416. 10.1097/MPG.0b013e31825f18ff.CrossRefPubMed
29.
Nordyke K, Norstrom F, Lindholm L, Carlsson A, Danielsson L, Emmelin M, Hogberg L, Karlsson E, Ivarsson A: Health-related quality-of-life in children with coeliac disease, measured prior to receiving their diagnosis through screening. J Med Screen. 2011, 18 (4): 187-192. 10.1258/jms.2011.011081.CrossRefPubMed
30.
de Lorenzo CM, Xikota JC, Wayhs MC, Nassar SM, de Souza Pires MM: Evaluation of the quality of life of children with celiac disease and their parents: a case–control study. Qual Life Res. 2012, 21 (1): 77-85. 10.1007/s11136-011-9930-7.CrossRefPubMed
31.
Altobelli E, Paduano R, Gentile T, Caloisi C, Marziliano C, Necozione S, di Orio F: Health-related quality of life in children and adolescents with celiac disease: survey of a population from central Italy. Health Qual Life Outcomes. 2013, 11: 204-10.1186/1477-7525-11-204.CrossRefPubMedPubMedCentral
32.
Ivarsson A, Myleus A, Norstrom F, van der Pals M, Rosen A, Hogberg L, Danielsson L, Halvarsson B, Hammarroth S, Hernell O, Karlsson E, Stenhammar L, Webb C, Sandstrom O, Carlsson A: Prevalence of childhood celiac disease and changes in infant feeding. Pediatrics. 2013, 131 (3): e687-e694. 10.1542/peds.2012-1015.CrossRefPubMed
33.
Webb C, Halvarsson B, Norstrom F, Myleus A, Carlsson A, Danielsson L, Hogberg L, Ivarsson A, Karlsson E, Stenhammar L, Sandstrom O: Accuracy in celiac disease diagnostics by controlling the small-bowel biopsy process. J Pediatr Gastroenterol Nutr. 2011, 52 (5): 549-553. 10.1097/MPG.0b013e3181fa434f.CrossRefPubMed
34.
Rosen A, Sandstrom O, Carlsson A, Hogberg L, Olen O, Stenlund H, Ivarsson A: Usefulness of symptoms to screen for celiac disease. Pediatrics. 2014, 133 (2): 211-218. 10.1542/peds.2012-3765.CrossRefPubMed
35.
Cohen J: Statistical Power Analysis for Behavioral Sciences. 1977, New York: Academic Press
36.
van Koppen EJ, Schweizer JJ, Csizmadia CG, Krom Y, Hylkema HB, van Geel AM, Koopman HM, Verloove-Vanhorick SP, Mearin ML: Long-term health and quality-of-life consequences of mass screening for childhood celiac disease: a 10-year follow-up study. Pediatrics. 2009, 123 (4): e582-e588. 10.1542/peds.2008-2221.CrossRefPubMed
37.
Kolsteren MM, Koopman HM, Schalekamp G, Mearin ML: Health-related quality of life in children with celiac disease. J Pediatr. 2001, 138 (4): 593-595. 10.1067/mpd.2001.111504.CrossRefPubMed
38.
van Doorn RK, Winkler LM, Zwinderman KH, Mearin ML, Koopman HM: CDDUX: a disease-specific health-related quality-of-life questionnaire for children with celiac disease. J Pediatr Gastroenterol Nutr. 2008, 47 (2): 147-152. 10.1097/MPG.0b013e31815ef87d.CrossRefPubMed
39.
Wagner G, Berger G, Sinnreich U, Grylli V, Schober E, Huber WD, Karwautz A: Quality of life in adolescents with treated coeliac disease: influence of compliance and age at diagnosis. J Pediatr Gastroenterol Nutr. 2008, 47 (5): 555-561. 10.1097/MPG.0b013e31817fcb56.CrossRefPubMed
40.
Barratt SM, Leeds JS, Sanders DS: Quality of life in Coeliac Disease is determined by perceived degree of difficulty adhering to a gluten-free diet, not the level of dietary adherence ultimately achieved. J Gastrointestin Liver Dis. 2011, 20 (3): 241-245.PubMed
41.
Kurppa K, Lauronen O, Collin P, Ukkola A, Laurila K, Huhtala H, Maki M, Kaukinen K: Factors associated with dietary adherence in celiac disease: a nationwide study. Digestion. 2012, 86 (4): 309-314. 10.1159/000341416.CrossRefPubMed
42.
Swedish National Institute of Public Health: Kartläggning av psykisk hälsa bland barn och unga. Resultat från den nationella totalundersökningen i årskurs 6 och 9 hösten 2009. 2011, Upplaga 2. Östersund: Statens folkhälsoinstitut, Available at http://​www.​folkhalsomyndigh​eten.​se
43.
Torsheim T, Currie C, Boyce W, Kalnins I, Overpeck M, Haugland S: Material deprivation and self-rated health: a multilevel study of adolescents from 22 European and North American countries. Soc Sci Med. 2004, 59 (1): 1-12. 10.1016/j.socscimed.2003.09.032.CrossRefPubMed
44.
Myleus A, Hernell O, Gothefors L, Hammarstrom ML, Persson LA, Stenlund H, Ivarsson A: Early infections are associated with increased risk for celiac disease: an incident case-referent study. BMC Pediatr. 2012, 12 (1): 194-10.1186/1471-2431-12-194.CrossRefPubMedPubMedCentral
45.
Wingren CJ, Bjorck S, Lynch KF, Ohlsson H, Agardh D, Merlo J: Coeliac disease in children: a social epidemiological study in Sweden. Acta Paediatr. 2012, 101 (2): 185-191. 10.1111/j.1651-2227.2011.02434.x.CrossRefPubMed
46.
Ludvigsson JF: Socio-economic characteristics in children with coeliac disease. Acta Paediatr. 2005, 94 (1): 107-113. 10.1080/08035250410018274.CrossRefPubMed
47.
Olen O, Bihagen E, Rasmussen F, Ludvigsson JF: Socioeconomic position and education in patients with coeliac disease. Dig Liver Dis. 2012, 44 (6): 471-476. 10.1016/j.dld.2012.01.006.CrossRefPubMed
48.
Hauser W, Stallmach A, Caspary WF, Stein J: Predictors of reduced health-related quality of life in adults with coeliac disease. Aliment Pharmacol Ther. 2007, 25 (5): 569-578.CrossRefPubMed
Metadata
Title
Health-related quality of life is not impaired in children with undetected as well as diagnosed celiac disease: a large population based cross-sectional study
Authors
Anna Myléus
Solveig Petersen
Annelie Carlsson
Solveig Hammarroth
Lotta Högberg
Anneli Ivarsson
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-425

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue

Research article

Socioeconomic and demographic predictors of selected cardiovascular risk factors among adults living in Pohnpei, Federated States of Micronesia

Research article

Educational differences in cigarette smoking among adult population in Estonia, 1990–2010: does the trend fit the model of tobacco epidemic?

Research article

Strategies to promote uptake and use of intimate partner violence and child maltreatment knowledge: an integrative review

Research article

Use of traditional medicines to cope with climate-sensitive diseases in a resource poor setting in Bangladesh

Research article

Increase in condom use and decline in prevalence of sexually transmitted infections among high-risk men who have sex with men and transgender persons in Maharashtra, India: Avahan, the India AIDS Initiative

Research article

Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization: registry data linked to population-based representative postal surveys