{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:42:11Z","timestamp":1791812531983,"version":"4.3.4"},"reference-count":42,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T00:00:00Z","timestamp":1728345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The only treatment for Celiac Disease (CeD), which affects about 1% of the population, is a gluten-free diet (GFD). Studies have indicated an association between the GFD, a diminished quality of life (QOL), and maladaptive eating patterns. This study aims to explore food avoidance behaviors in adults with CeD. Methods: This cross-sectional study assessed 50 adults with biopsy-confirmed CeD who completed validated surveys evaluating demographics, psychological factors, QOL, eating pathology, and food avoidance. Results: Overall CDQOL scores were good (mean: 62.7 out of 100). However, 58.0% of the participants self-elected to avoid one or more additional foods without diagnosed allergies or intolerances. Those avoiding one or more other foods had lower QOL scores (57.4 (23.2) vs. 70.2 (15.9)) compared to those only avoiding gluten (p = 0.034). The mean depression score (CESD) for the group avoiding foods beyond gluten was in the depressive range, unlike those avoiding only gluten (16.0 (4.9) vs. 13.6 (4.0), p = 0.078), with 77% of those avoiding more than gluten scoring above the CESD cut-off point of 15, indicating clinical depression. Conclusions: Over half of participants (58%) reported avoiding additional foods beyond the GFD, a behavior associated with decreased QOL and increased depression.<\/jats:p>","DOI":"10.3390\/nu16193411","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T12:01:54Z","timestamp":1728388914000},"page":"3411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Food Avoidance beyond the Gluten-Free Diet and the Association with Quality of Life and Eating Attitudes and Behaviors in Adults with Celiac Disease"],"prefix":"10.3390","volume":"16","author":[{"given":"Anne R.","family":"Lee","sequence":"first","affiliation":[{"name":"Celiac Disease Center at Columbia University, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Zybert","sequence":"additional","affiliation":[{"name":"Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6716-5793","authenticated-orcid":false,"given":"Zhijun","family":"Chen","sequence":"additional","affiliation":[{"name":"Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Lebovits","sequence":"additional","affiliation":[{"name":"Celiac Disease Center at Columbia University, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randi L.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Lebwohl","sequence":"additional","affiliation":[{"name":"Celiac Disease Center at Columbia University, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H. R.","family":"Green","sequence":"additional","affiliation":[{"name":"Celiac Disease Center at Columbia University, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1159\/000370204","article-title":"Clinical manifestations of celiac disease","volume":"33","author":"Green","year":"2015","journal-title":"Dig. Dis."},{"key":"ref_2","first-page":"14721477","article-title":"Celiac disease patients presenting with anemia have more severe disease than those presenting with diarrhea","volume":"11","author":"Lebwohl","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1146\/annurev.med.57.051804.122404","article-title":"Celiac Disease","volume":"57","author":"Green","year":"2006","journal-title":"Annu. Rev. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/S0140-6736(99)04855-2","article-title":"Severe osteopenia in symptom-free adults with a childhood diagnosis of coeliac disease","volume":"355","author":"Cellier","year":"2000","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/ajcn\/69.3.354","article-title":"The widening spectrum of celiac disease","volume":"69","author":"Murray","year":"1999","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1038\/ajg.2012.219","article-title":"The prevalence of celiac disease in the United States","volume":"107","author":"Ludvigsson","year":"2012","journal-title":"Am. J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1111\/j.1365-2036.2007.03502.x","article-title":"Increasing prevalence of coeliac disease over time","volume":"26","author":"Lohi","year":"2007","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1136\/gutjnl-2013-306578","article-title":"Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology","volume":"63","author":"Ludvigsson","year":"2014","journal-title":"Gut"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1093\/ajcn\/81.6.1452","article-title":"Effects of a gluten-free diet on gastrointestinal symptoms in celiac disease","volume":"81","author":"Hornell","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/00042737-200106000-00008","article-title":"The serum IgA class anti-tissue transglutaminase antibodies in the diagnosis and follow up of coeliac disease. Results of an international multi-centre study. International WorkingGroup on Eu-tTG","volume":"13","author":"Fabiani","year":"2001","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/ajcn\/85.1.160","article-title":"A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease","volume":"85","author":"Catassi","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1038\/ajg.2014.29","article-title":"Patient perception of treatment burden is high in celiac disease compared with other common conditions","volume":"109","author":"Shah","year":"2014","journal-title":"Am. J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1365-277X.2012.01236.x","article-title":"Living with coeliac disease: Survey results from the U.S.A","volume":"25","author":"Lee","year":"2012","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s10620-006-9258-2","article-title":"The Canadian Celiac Health Survey","volume":"52","author":"Cranney","year":"2007","journal-title":"Dig. Dis. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1111\/j.1365-277X.2011.01170.x","article-title":"Impact of celiac disease on dietary habits and quality of life","volume":"24","author":"Black","year":"2011","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Gray, A.M., and Papanicolas, I.N. (2010). Impact of symptoms on quality of life before and after diagnosis of celiac disease: Results from a UK population survey. BMC Health Serv. Res., 10.","DOI":"10.1186\/1472-6963-10-105"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/jhn.12638","article-title":"Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten-free diet: A cross-sectional, mixed-methods study","volume":"32","author":"Cadenhead","year":"2019","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1365-277X.2005.00591.x","article-title":"\u2018Controlled by food\u2019-lived experiences of coeliac disease","volume":"18","author":"Sverker","year":"2005","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Santonicola, A., Gagliardi, M., Guarino, M.P.L., Siniscalchi, M., Ciacci, C., and Iovino, P. (2019). Eating Disorders and Gastrointestinal Diseases. Nutrients, 11.","DOI":"10.3390\/nu11123038"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/MEG.0b013e328012db37","article-title":"The interaction between eating disorders and celiac disease: An exploration of 10 cases","volume":"19","author":"Leffler","year":"2007","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e20164367","DOI":"10.1542\/peds.2016-4367","article-title":"Celiac Disease and Anorexia Nervosa: A Nationwide Study","volume":"139","author":"Bulik","year":"2017","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Alkalay, M.J. (2021). Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Rel ated Disorders. Nutrients, 14.","DOI":"10.3390\/nu14010002"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.2147\/NDT.S124168","article-title":"Anorexia nervosa of the restrictive type and celiac disease in adolescence","volume":"13","author":"Nacinovich","year":"2017","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/jhn.12475","article-title":"Disordered eating patterns in coeliac disease: A framework analysis","volume":"30","author":"Satherley","year":"2017","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_25","unstructured":"Grilo, C. (2012). Eating and Weight Disorders, Psychology Press."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/1742395311417639","article-title":"Psychiatric comorbidities in women with celiac disease","volume":"8","author":"Arigo","year":"2012","journal-title":"Chronic Illn."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S0022-3999(97)00269-9","article-title":"A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment","volume":"44","author":"Rosen","year":"1998","journal-title":"J. Psychosom. Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"G\u0142ady\u015b, K., Dardzi\u0144ska, J., Guzek, M., Adrych, K., Kochan, Z., and Ma\u0142gorzewicz, S. (2021). Expanded Role of a Dietitian in Monitoring a Gluten-Free Diet in Patients with Celiac Disease: Implications for Clinical Practice. Nutrients, 13.","DOI":"10.3390\/nu13061859"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.appet.2016.07.038","article-title":"The prevalence and predictors of disordered eating in women with coeliac disease","volume":"107","author":"Satherley","year":"2016","journal-title":"Appetite"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.1007\/s10620-023-07912-6","article-title":"Maladaptive Food Attitudes and Behaviors in Individuals with Celiac Disease and Their Association with Quality of Life","volume":"68","author":"Gholmie","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1016\/j.cgh.2009.07.031","article-title":"A validated disease-specific symptom index for adults with celiac disease","volume":"7","author":"Leffler","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1111\/j.1365-2036.2009.04220.x","article-title":"The development and validation of a new coeliac disease quality of life survey (CD-QOL)","volume":"31","author":"Dorn","year":"2009","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D scale: A self-report depression scale for research in the general population","volume":"1","author":"Radloff","year":"1977","journal-title":"Appl. Psychol. Meas."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Spielberger, C.D., Gorsuch, R.L., Lushene, R., and Vagg, P.R. (1983). Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press.","DOI":"10.1037\/t06496-000"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1002\/eat.22180","article-title":"Gender norms, psychometric properties, and validity for the Eating Pathology Symptoms Inventory","volume":"47","author":"Forbush","year":"2014","journal-title":"Int. J. Eat. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6930269","DOI":"10.1155\/2018\/6930269","article-title":"Development and Validation of the Coeliac Disease Food Attitudes and Behaviours Scale","volume":"2018","author":"Satherley","year":"2018","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40519-018-0605-z","article-title":"Disordered eating behaviors in adolescents with celiac disease","volume":"25","author":"Latzer","year":"2018","journal-title":"Eat. Weight. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Lee, A.R., Lebwohl, B., Lebovits, J., Wolf, R.L., Ciaccio, E.J., and Green, P.H.R. (2021). Factors Associated with Maladaptive Eating Behaviors, Social Anxiety, and Quality of Life in Adults with Celiac Disease. Nutrients, 13.","DOI":"10.3390\/nu13124494"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5158","DOI":"10.1007\/s10620-022-07548-y","article-title":"Impact of Celiac Disease on Dating","volume":"67","author":"Lebovits","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Joelson, A.M., Geller, M.G., Zylberberg, H.M., Green, P.H.R., and Lebwohl, B. (2018). The Effect of Depressive Symptoms on the Association between Gluten-Free Diet Adherence and Symptoms in Celiac Disease: Analysis of a Patient Powered Research Network. Nutrients, 10.","DOI":"10.3390\/nu10050538"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s11894-023-00900-w","article-title":"ARFID at 10 years: A Review of Medical, Nutritional and Psychological Evaluation and Management","volume":"25","author":"Fisher","year":"2023","journal-title":"Curr. Gastroenterol. Rep."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/19\/3411\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:09:28Z","timestamp":1760112568000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/19\/3411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,8]]},"references-count":42,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["nu16193411"],"URL":"https:\/\/doi.org\/10.3390\/nu16193411","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,8]]}}}