Skip to main content

Advertisement

SpringerLink
Log in

Obesogenic habits among children and their families in response to initiation of gluten-free diet

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Initiation of a lifelong, gluten-free diet (GFD) in children with celiac disease (CD) influences the child’s life in many ways. The aim of this study was to assess the influence of GFD on the child and his/her family’s eating habits and lifestyle behaviors. To study this, we asked children and their parents completed the Family Eating and Activity Habits Questionnaire (FEAHQ) at the time of diagnosis of CD and at least 6 months after initiation of GFD and a questionnaires assessing symptoms related to CD and adherence to the GFD diet. We analyzed questionnaires from 40 children with CD and their families. There were 21 females, ranging in age from 4 to 15.7 years (median age 7.4 years±2.8 years). The control group comprised 15 healthy children. After initiation of GFD the family ate more junk food including snacks and candies (p = 0.05), with the significant change reported by children and fathers (p = 0.001 and 0.03 respectively). All family members in the control group had significantly less snacks. Parents and children reported a significant increase in obesogenic eating styles, such as eating from the cooking pot and eating while doing other activities (mothers, p = 0.001; fathers, 0.02; and children, 0.02 respectively).

Conclusions: Our study shows that initiation of GFD in children with CD leads to changes in eating habits and staple food eating that may lead to a more obesogenic environment. Care givers, pediatricians, gastroenterologists, and dieticians alike should be aware of these implications and educate families towards a healthier lifestyle and diet beyond the GFD itself.

What’s Known:

• Gluten-free diet has been shown to affect various psychosocial aspects of children with celiac disease.

• Obesity and celiac are associated.

What is New:

• Initiation of gluten-free diet led to increased eating of junk food both in the patient and his/her family.

• After initiation of GFD pro-obesogenic eating habits is increased.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

GFD:

Gluten-Free Diet

CD:

Celiac Disease

FEAHQ:

Family Eating and Activity Habits Questionnaire

GFF:

Gluten-Free Food

BMI:

Body Mass Index

References

  1. Aurangzeb B, Leach ST, Lemberg DA, Day AS (2010) Nutritional status of children with coeliac disease. Acta Paediatr 99:1020–1025

    Article  PubMed  CAS  Google Scholar 

  2. Bacigalupe G, Plocha A (2015) Celiac is a social disease: family challenges and strategies. Fam Syst Health 33:46–54

    Article  PubMed  Google Scholar 

  3. Brambilla P, Picca M, Dilillo D, Meneghin F, Cravidi C, Tischer MC, Vivaldo T, Bedogni G, Zuccotti GV (2013) Changes of body mass index in celiac children on a gluten-free diet. Nutr Metab Cardiovasc Dis 23:177–182

    Article  PubMed  CAS  Google Scholar 

  4. Cederborg AC, Hultman E, Magnusson KF (2012) Living with children who have coeliac disease: a parental perspective. Child Care Health Dev 38:484–489

    Article  PubMed  Google Scholar 

  5. Epifanio MS, Genna V, Vitello MG, Roccella M, La Grutta S (2013) Parenting stress and impact of illness in parents of children with coeliac disease. Pediatr Rep 5:e19

    Article  PubMed  PubMed Central  Google Scholar 

  6. Golan M (2014) Fifteen years of the Family Eating and Activity Habits Questionnaire (FEAHQ): an update and review. Pediatr Obes 9:92–101

    Article  PubMed  CAS  Google Scholar 

  7. Golan M, Weizman A (1998) Reliability and validity of the family eating and activity habits questionnaire. Eur J Clin Nutr 52:771–777

    Article  PubMed  CAS  Google Scholar 

  8. Golan M, Fainaru M, Weizman A (1998) Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Dis: J Int Assoc Stud Obes 22:1217–1224

    Article  CAS  Google Scholar 

  9. Hallert C, Granno C, Hulten S et al (2002) Living with coeliac disease: controlled study of the burden of illness. Scand J Gastroenterol 37:39–42

    Article  PubMed  CAS  Google Scholar 

  10. Heerman WJ, Jackson N, Hargreaves M et al (2017) Clusters of healthy and unhealthy eating behaviors are associated with body mass index among adults. J Nutr Educ Behav 49:415–421.e411

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hopman EG, le Cessie S, von Blomberg BM, Mearin ML (2006) Nutritional management of the gluten-free diet in young people with celiac disease in The Netherlands. J Pediatr Gastroenterol Nutr 43:102–108

    Article  PubMed  CAS  Google Scholar 

  12. Howarth NC, Saltzman E, Roberts SB (2001) Dietary fiber and weight regulation. Nutr Rev 59:129–139

    Article  PubMed  CAS  Google Scholar 

  13. Husby S, Koletzko S, Korponay-Szabo IR et al (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54:136–160

    Article  PubMed  CAS  Google Scholar 

  14. Jago R, Page AS, Cooper AR (2012) Friends and physical activity during the transition from primary to secondary school. Med Sci Sports Exerc 44:111–117

    Article  PubMed  Google Scholar 

  15. Kabbani TA, Goldberg A, Kelly CP, Pallav K, Tariq S, Peer A, Hansen J, Dennis M, Leffler DA (2012) Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment Pharmacol Ther 35:723–729

    Article  PubMed  CAS  Google Scholar 

  16. Krulik T, Turner-Henson A, Kanematsu Y, al-Ma'aitah R, Swan J, Holaday B (1999) Parenting stress and mothers of young children with chronic illness: a cross-cultural study. J Pediatr Nurs 14:130–140

    Article  PubMed  CAS  Google Scholar 

  17. Kuczmarski RJ, Ogden CL, Guo SS et al 2000 CDC growth charts for the United States: methods and development. Vital and health statistics. Series 11, Data from the national health survey 2002:1–190

  18. Mariani P, Viti MG, Montuori M et al (1998) The gluten-free diet: a nutritional risk factor for adolescents with celiac disease? J Pediatr Gastroenterol Nutr 27:519–523

    Article  PubMed  CAS  Google Scholar 

  19. Meyer S, Rosenblum S (2016) Children with celiac disease: health-related quality of life and leisure participation. Am J Occup Ther 70:7006220010p7006220011-7006220010p7006220018

  20. Nevanperä NJHL, Kuosma E, Ukkola O, Uitti J, Laitinen JH (2012) Occupational burnout, eating behavior, and weight among working women. Am J Clin Nutr 95:934–943

    Article  PubMed  CAS  Google Scholar 

  21. Norsa L, Shamir R, Zevit N, Verduci E, Hartman C, Ghisleni D, Riva E, Giovannini M (2013) Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets. World J Gastroenterol 19:5658–5664

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ohlund K, Olsson C, Hernell O, Ohlund I (2010) Dietary shortcomings in children on a gluten-free diet. J Hum Nutr diet: the official J Br Diet Assoc 23:294–300

    Article  CAS  Google Scholar 

  23. Ovaskainen ML, Reinivuo H, Tapanainen H, Hannila ML, Korhonen T, Pakkala H (2006) Snacks as an element of energy intake and food consumption. Eur J Clin Nutr 60:494–501

    Article  PubMed  Google Scholar 

  24. Ozier AD, Kendrick OW, Leeper JD, Knol LL, Perko M, Burnham J (2008) Overweight and obesity are associated with emotion- and stress-related eating as measured by the eating and appraisal due to emotions and stress questionnaire. J Am Diet Assoc 108:49–56

    Article  PubMed  Google Scholar 

  25. Padalino L, Conte A, Del Nobile MA (2016) Overview on the general approaches to improve gluten-free pasta and bread. Foods;5

  26. Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV (2013) Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients 5:4553–4565

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Perricone G, Guerra MP, Cruz O, Polizzi C, Lima L, Morales MR, de Lemos MS, Fontana V (2013) Maternal coping strategies in response to a child’s chronic and oncological disease: a cross-cultural study in Italy and Portugal. Pediatric reports 5:43–47

    PubMed  PubMed Central  Google Scholar 

  28. Quittner AL, DiGirolamo AM, Michel M, Eigen H (1992) Parental response to cystic fibrosis: a contextual analysis of the diagnosis phase. J Pediatr Psychol 17:683–704

    Article  PubMed  CAS  Google Scholar 

  29. Reilly NR (2016) The gluten-free diet: recognizing fact, fiction, and fad. J Pediatr 175:206–210

    Article  PubMed  Google Scholar 

  30. Reilly NR, Aguilar K, Hassid BG et al (2011) Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr 53:528–531

    PubMed  Google Scholar 

  31. Shteyer E, Berson T, Lachmanovitz O, Hidas A, Wilschanski M, Menachem M, Shachar E, Shapira J, Steinberg D, Moskovitz M (2013) Oral health status and salivary properties in relation to gluten-free diet in children with celiac disease. J Pediatr Gastroenterol Nutr 57:49–52

    Article  PubMed  CAS  Google Scholar 

  32. Silventoinen K, Rokholm B, Kaprio J, Sorensen TI (2010) The genetic and environmental influences on childhood obesity: a systematic review of twin and adoption studies. Int J Obes 34:29–40

    Article  CAS  Google Scholar 

  33. Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK (2005) Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet 18:163–169

    Article  PubMed  CAS  Google Scholar 

  34. Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F, Danchielli C (2010) Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr 64:1371–1372

    Article  PubMed  CAS  Google Scholar 

  35. van Doorn RK, Winkler LM, Zwinderman KH, Mearin ML, Koopman HM (2008) CDDUX: a disease-specific health-related quality-of-life questionnaire for children with celiac disease. J Pediatr Gastroenterol Nutr 47:147–152

    Article  PubMed  Google Scholar 

  36. Wagner G, Berger G, Sinnreich U, Grylli V, Schober E, Huber WD, Karwautz A (2008) Quality of life in adolescents with treated coeliac disease: influence of compliance and age at diagnosis. J Pediatr Gastroenterol Nutr 47:555–561

    Article  PubMed  Google Scholar 

  37. Zuccotti G, Fabiano V, Dilillo D, Picca M, Cravidi C, Brambilla P (2013) Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products. J Hum Nutr Diet 26:436–444

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

No external funding for this manuscript.

Author information

Authors and Affiliations

  1. Pediatric Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel

    Neriya Levran, Michael Wilschanski, Jessica Livovsky, Edna Shachar & Eyal Shteyer

  2. Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel

    Moti Moskovitz & Lama Assaf-Jabrin

  3. The Juliet Keidan Institute of Pediatric Gastroenterology, Pediatric Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel

    Eyal Shteyer

Authors
  1. Neriya Levran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Wilschanski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica Livovsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edna Shachar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Moti Moskovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lama Assaf-Jabrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eyal Shteyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NL: nutritional guidance for the patients, recruiting and assessing the patients and writing the manuscript.

MW: recruiting and assessing the patients and writing the manuscript.

JL: nutritional guidance for the patients.

MM: recruiting and assessing the control group.

LAJ: recruiting and assessing the control group.

ES: recruiting and assessing the patients and writing the manuscript.

Corresponding author

Correspondence to Eyal Shteyer.

Ethics declarations

Conflict of interest

The authors declare that they have they have no conflict of interest.

Financial disclosure

All authors have indicated they have no financial relationships relevant to this article to disclose.

Informed consent

The study protocol was approved by the institutional review board (IRB) human ethics Committee of Hadassah (application 0290-12, 7/2012). Informed consent was obtained from all the parents or legal guardians of the participating children.

Additional information

Communicated by Peter de Winter

Electronic supplementary material

ESM 1

(DOC 670 kb)

ESM 2

(DOCX 21 kb)

ESM 3

(DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levran, N., Wilschanski, M., Livovsky, J. et al. Obesogenic habits among children and their families in response to initiation of gluten-free diet. Eur J Pediatr 177, 859–866 (2018). https://doi.org/10.1007/s00431-018-3128-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-018-3128-8

Keywords

Search

Navigation