Does Having Celiac Disease Increase the Risk of Eating Disorders? A Systematic Review

Abstract

Context: Celiac disease (CD) requires lifelong adherence to a gluten-free diet (GFD), which may contribute to disordered eating behaviors (DEBs) and increased eating disorder (ED) risk. Objective: To systematically evaluate the association between CD and ED risk, including disordered eating, orthorexia nervosa, ARFID, and related psychosocial factors. Data Sources: A systematic search of EBSCOHost, PubMed, Scopus, and SFA’s Steen Library identified 568 records prior to deduplication using terms related to celiac disease, gluten-free diet, and eating disorders. The review followed PRISMA 2020 guidelines. Data Extraction: Studies were screened using predefined inclusion criteria. Data extracted included study design, participant characteristics, assessment tools, and outcomes. Study quality and risk of bias were assessed using the Academy of Nutrition and Dietetics Evidence Analysis Library Quality Criteria Checklist. Data Analysis: A narrative synthesis was conducted due to heterogeneity across studies. Findings suggested ED risk in individuals with CD ranged from 6.8% to 43.5%, with evidence of restrictive eating patterns, orthorexic tendencies, ARFID symptoms, and psychosocial distress associated with GFD burden. Conclusions: Current evidence suggests individuals with CD may be vulnerable to disordered eating behaviors, although variability in study quality and methods limits definitive conclusions. Further longitudinal research is needed to clarify mechanisms and inform screening and nutrition care practices.