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Is it the gluten-free diet that matters the most?: Food, gender and celiac disease
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The only treatment for celiac disease consists of excluding gluten. Gluten is a protein complex found in wheat, rye, and barley, which are cereals commonly used in bread, pasta, pizza, etc. The overall aims of this thesis were to study; what happens with food choices and nutrient intakes when individuals are prescribed a gluten-free diet and what consequences this has on the everyday lives of young women and young men dealing with this disease.

Methods: A food frequency questionnaire (FFQ) was used to study nutrient intake and how food choices were affected after a change to a gluten-free diet. The FFQ was sent to 12-13 years-old adolescents who took part in a large Swedish celiac screening study. The following three groups were studied: previously diagnosed with celiac disease, screening-diagnosed and non-celiac controls. The first FFQ was sent out before the screening-diagnosed adolescents had been told they had celiac disease, and the second was sent 12-18 months after they had been prescribed the gluten-free treatment. Semi-structured interviews were performed five years later in order to study how everyday life was affected by celiac disease in seven young women and seven young men. The interviews were analyzed by content analysis.

Results: The previously diagnosed celiac disease group reported a nutrient intake in line with the non-celiac control group. Most of the participants reported nutrient intakes above the estimated average requirements. A diagnosis of celiac disease altered the intake of some foods, and this was shown by comparing the results from the baseline FFQ before the diagnosis and the follow-up FFQ after. The young women and young men reported similar experiences of the gluten-free food, but the perceived consequences of living with celiac disease differed between genders.

Conclusion: This thesis shows that after a diagnosis of celiac disease food changes are necessary in order to be compliant with the gluten-free diet. One common effect is that food options will be reduced. However, as long the food intake is gluten-free, varied, and in sufficient quantity there is no reason to worry more about the nutritional intake of adolescents diagnosed with celiac disease than there is for their non-celiac peers. The findings in this thesis also show that society’s gender order has a great impact on how young women and young men experience their everyday lives, with celiac disease, and with the gluten-free diet.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2014. , 76 p.
Keyword [en]
celiac disease, gluten-free diet, gender, dietary assessment, adolescents, qualitative interviews
National Category
Other Social Sciences not elsewhere specified Nutrition and Dietetics
Research subject
Food and Nutrition
Identifiers
URN: urn:nbn:se:umu:diva-85866ISBN: 978-91-7601-014-3 (print)OAI: oai:DiVA.org:umu-85866DiVA: diva2:698282
Public defence
2014-03-21, Hörsal D, Samhällsvetarhuset, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-02-28 Created: 2014-02-12 Last updated: 2015-11-04Bibliographically approved
List of papers
1. Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries
Open this publication in new window or tab >>Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries
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2014 (English)In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 27, no 1, 41-53 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Food habits, nutrient needs and intakes differ between males and females, although few nutritional studies on patients with coeliac disease (CD) have reported results stratified by gender.

OBJECTIVES: To compare energy and nutrient intakes among 13-year olds diagnosed with CD in early childhood with those of a non-coeliac (NC) age- and gender-matched control group, and also with estimated average requirements (EAR).

METHODS: A case-control study was conducted in Sweden 2006-2007 within the coeliac screening study ETICS (Exploring The Iceberg of Coeliacs in Sweden). Dietary intake was assessed among 37 adolescents (23 girls) diagnosed with CD at median age 1.7 years (CD group) and 805 (430 girls) NC controls (NC group) using a food-frequency questionnaire covering 4 weeks. Reported energy intake was validated by comparison with the calculated physical activity level (PAL).

RESULTS: Regardless of CD status, most adolescents reported an intake above EAR for most nutrients. However, both groups had a low intake of vitamin C, with 13% in the CD-group and 25% in the NC-group below EAR, and 21% of boys in the CD-group below EAR for thiamine. The intake of fatty acids was unbalanced, with a high intake of saturated and a low intake of unsaturated fats. Girls and boys in the CD-group had an overall lower nutrient density in reported food intake compared to girls and boys in the NC-group.

CONCLUSIONS: Nutrient intake of adolescent girls and boys with CD was mostly comparable to intakes of NC controls. Dietitians should take the opportunity to reinforce a generally healthy diet when providing information about the gluten-free diet.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keyword
adolescents, dietary assessment, coeliac disease, gluten-free diet
National Category
Nutrition and Dietetics Gender Studies
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-71406 (URN)10.1111/jhn.12125 (DOI)000331176600004 ()23701396 (PubMedID)2-s2.0-84893683278 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2005-0802Formas, 222-2004-1918Formas, 222-2007-1394Swedish Research Council, 521-2007-2953Swedish Research Council, 521-2004-7093EU, European Research Council, FP6-2005-FOOD-4B-36383–PREVENTCD
Available from: 2013-05-28 Created: 2013-05-28 Last updated: 2017-12-06Bibliographically approved
2. What happens to food choices when a gluten-free diet is required?: A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers
Open this publication in new window or tab >>What happens to food choices when a gluten-free diet is required?: A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers
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2014 (English)In: Journal of Nutritional Science, ISSN 2048-6790, E-ISSN 2048-6790, Vol. 3, no e2Article in journal (Refereed) Published
Abstract [en]

A dietary survey was performed during a large screening study in Sweden among 13-year-old adolescents. The aim was to study how the intake of food groups was affected by a screening-detected diagnosis of celiac disease (CD) and its gluten-free (GF) treatment. Food intake, was reported using a food frequency questionnaires (FFQ) and intake reported by the adolescents who was screened to CD was compared with the intake of two same-aged referent groups: i) adolescents diagnosed to CD prior screening and ii) adolescents without CD.. The food intake groups were measured at baseline before the screening-detected cases were aware of their CD, and 12-18 months later.

The result showed that the food intakes are affected by a screen detected CD and its dietary treatment. Many flour-based foods were reduced such as pizza, fish fingers, and pastries. The result also indicated that the bread intake was lower before the screened diagnosis compared to the other studied groups, but increased afterwards. Specially manufactured GF-products (e.g. pasta and bread) were frequently used in the screened CDgroup after changing to a GF-diet. Our results suggest that changing to a GF-diet reduces the intake of some popular foods, and the ingredients on the plate are altered, but this do not necessarily include a change of food groups. The availability of manufactured GF-replacement products makes it possible for adolescents to keep many of their old food habits when diagnosed with CD in Sweden.

Place, publisher, year, edition, pages
Cambridge University Press, 2014
Keyword
celiac disease, gluten-free diet, food choices, screening
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-86027 (URN)10.1017/jns.2013.24 (DOI)
Available from: 2014-02-17 Created: 2014-02-14 Last updated: 2017-12-06Bibliographically approved
3. An on-going gendered endeavour in silence: young women struggling with celiac disease
Open this publication in new window or tab >>An on-going gendered endeavour in silence: young women struggling with celiac disease
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Women with celiac disease are in the literature described as feeling exposed to negative emotions and experiences related to the treatment of celiac disease - the gluten-free diet. In order to explore the daily experiences of being diagnosed to celiac disease we interviewed seven Swedish young women diagnosed to celiac disease by screening in early adolescence. The semi structured interviews were analysed inductively by using content analysis. The analysis showed that the young women continued to strive with their treatment and their relations toward others, even years after diagnosis. The young women found themselves in an environment where their strict adherence to the dietary treatment was an obstacle and could prevent the feeling of connectedness. We argue that the emphasized/normative femininity that these young women relate to complicates their daily life diagnosed with celiac disease.

Keyword
Compliance, gluten-free diet, gender, women’s issues, young adults
National Category
Other Social Sciences not elsewhere specified Respiratory Medicine and Allergy Health Sciences
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-85864 (URN)
Available from: 2014-02-12 Created: 2014-02-12 Last updated: 2015-11-04Bibliographically approved
4. Living with celiac disease seen from a male perspective
Open this publication in new window or tab >>Living with celiac disease seen from a male perspective
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Men diagnosed with celiac disease are in earlier scientific studies known to be less troubled by their experiences of living with disease than women with celiac disease. Previous studies, concentrating on men with celiac disease have been mostly quantitative, and the studies has dealt with physiology and pathology. The aim of this study was to give voice to young men with screening-detected celiac disease and to highlight the situations that they encounter in their daily lives five years after the screening. Seven Swedish young men were interviewed. They had been diagnosed with celiac disease as 12-13 years-olds through a large Swedish school based celiac screening-study. The semi-structured interviews were analyzed from a gender perspective using content analysis. The findings resulted in a main theme, conquering the disease and becoming a man, which was underpinned by several themes and sub-themes. The analysis showed that the young men’s experiences of living with celiac disease in their daily life, largely depended on their use of characteristics known to be in accordance with dominating masculinity; such as being self-assured, demanding, and behaving authoritative. In food situations, when the young men had the ability to make use of such characteristics in their informal group, they experienced much less negative aspects of the disease. If the young men did not have a position in their informal group where they could develop those features, their situation was expressed as being tough, they were bullied and withdrew from social meals. It seemed important for the young men to dissociate themselves from being seen as a person who had a life-long chronic disease.

National Category
Other Social Sciences not elsewhere specified
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-86021 (URN)
Available from: 2014-02-17 Created: 2014-02-14 Last updated: 2015-11-04Bibliographically approved

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