Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK.
Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK; Centre for Behaviour Change, University College London, 1-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK.
Appetite. 2018 Jan 1;120:578-588. doi: 10.1016/j.appet.2017.10.017. Epub 2017 Oct 16.
Depressive symptoms are common in patients with coeliac disease (CD) and may represent a barrier to gluten free diet (GFD) adherence. The aims of this meta-analysis were: (1) to synthesise the evidence on the relationship between depression or depressive symptoms and degree of adherence to a GFD in patients with CD who are already attempting a GFD (i.e., post-diagnosis and onset of GFD), and (2) to summarise the direction of causation of any observed relationship.
A random effects meta-analysis of 8 cross-sectional studies (N = 1644) was conducted. Included studies measured self-reported depressive symptoms and GFD adherence using either a dietitian interview or validated self-report questionnaire that considered unintentional gluten consumption.
There was a moderate association between poorer GFD adherence and greater depressive symptoms (r = 0.398, 95% CI = 0.321-0.469), with marked heterogeneity in the effects (I = 66.8%). A sensitivity analysis excluding studies with a moderate/high (k = 1) or unclear risk of bias (k = 1) did not change the results.
The low number of studies meeting inclusion criteria limits the strength of the conclusions. Available evidence suggests there is an association between poorer GFD adherence and self-reported depressive symptoms; however, studies using longitudinal and prospective designs, and reliable measures, particularly for adherence, are needed to confirm this association. The direction of causation between depression and adherence remains unclear.
抑郁症状在乳糜泻（CD）患者中很常见，可能成为他们坚持无麸质饮食（GFD）的障碍。本荟萃分析的目的是：（1）综合已有研究证据，评估 CD 患者在开始进行 GFD 治疗后（即诊断后和开始 GFD 时）抑郁症状或抑郁程度与 GFD 依从性之间的关系；（2）总结任何观察到的关联的因果关系方向。
对 8 项横断面研究（N=1644）进行随机效应荟萃分析。纳入的研究使用营养师访谈或经过验证的自我报告问卷来评估抑郁症状和 GFD 依从性，这些问卷考虑了非故意的麸质摄入。
GFD 依从性差与抑郁症状更严重之间存在中度关联（r=0.398，95%置信区间=0.321-0.469），但效应存在显著异质性（I=66.8%）。敏感性分析排除了中度/高度（k=1）或不确定偏倚风险（k=1）的研究，结果没有改变。
符合纳入标准的研究数量较少，限制了结论的强度。现有证据表明，GFD 依从性差与自我报告的抑郁症状之间存在关联；然而，需要使用纵向和前瞻性设计以及可靠的方法，特别是针对依从性，来证实这种关联。抑郁和依从性之间的因果关系方向仍不清楚。
