Celiac Disease and Anorexia Nervosa: An Unusual Pairing or Not! :

Ever think that patients with celiac disease could have an increased association with anorexia nervosa? Ever wonder if patients with anorexia nervosa might also be experiencing celiac disease?  Perhaps you have never considered these disorders as being associated—although case reports have suggested such an association.  To determine if there is more than anecdote to this association, Marild et al. (10.1542/peds.2016-4367) share the results of using a registry-based cohort for a case-control study of close to 18,000 women with celiac disease who are sex and age-matched with controls to see if they or did not have an association with anorexia prior to or after diagnosis of biopsy proven celiac disease. There was an increased association of anorexia both before and after celiac disease was identified suggesting a bidirectional association even when confounders like socioeconomic status and type 1 diabetes were controlled for. So why would these two entities be associated?  The authors provide some discussion but we have also asked Drs. Neville Golden (adolescent specialist) and KT Park (gastroenterologist) from Stanford (10.1542/peds.2017-0545) to provide some gluten-free food for thought in an accompanying commentary.  Both the study and commentary are easy to digest but the fact that there is an increased association between these two entities should weigh more heavily with you when presented with one or the other so that appropriate diagnostic and therapeutic follow-up work can ensue.