Researchers observed a bidirectional association between diagnoses of anorexia nervosa and celiac disease, according to a study published in Pediatrics.

Karl Marild, MD, PhD, from the University of Colorado, and colleagues conducted a register-based cohort and case-control study that included women diagnosed with celiac disease (n=17,959) and sex and age-matched population-based controls (n=89,379).  The researchers identified celiac disease through the histopathology records of Sweden’s 28 pathology departments, and they used inpatient and hospital-based outpatient records to identify anorexia nervosa.

A total of 54 patients with celiac disease were diagnosed with anorexia nervosa during 1,174,401 person-years of follow-up (27/100,000 person-years) compared with 180 matched controls (18/100,000 person-years).

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The hazard ratio for later anorexia nervosa was 1.46 and 1.31 beyond the first year after a celiac disease diagnosis. A previous anorexia nervosa diagnosis was also associated with celiac disease (odds ratio, 2.18). The estimates were unchanged when adjusted for socioeconomic characteristics and type 1 diabetes.

“The positive association of CD [celiac disease] with AN [anorexia nervosa], both before and after CD diagnosis, should spur a careful initial assessment and follow-up of these illnesses,” the study authors wrote.

“It should also be appreciated that the 2 conditions can complicate each other. Having AN makes it harder to follow a gluten-free diet, and it cannot be excluded that some AN patients knowingly consume gluten-containing products to lose weight.‍ The treatment of AN and CD require different competences and a multidisciplinary approach to management is important.”


  1. Marild K, Stordal K, Bulik CM, Rewers M, Ekbom A, Liu E, Ludvigsson JF. Celiac disease and anorexia nervosa: A nationwide study. Pediatrics. 2017. doi:10.1542/peds.2016-4367