Before diagnosis and after, frailty is common in those diagnosed at 60 years or more, study finds
By Amy Ratner, director of scientific affairs
Although celiac disease is being diagnosed more often in older people, little research has been focused on the specific complications faced by older adults. An international group of researchers recently set out to determine whether those diagnosed with celiac disease at 60 years or more had a greater risk of being frail than their peers.
They found older adults with celiac disease were more likely to be frail before diagnosis compared to their peers without celiac disease. Those with celiac disease who were not frail before diagnosis were also significantly more at risk of becoming frail within five years of their diagnosis than their peers without celiac disease.
An increased risk of frailty was also seen at one and three years after diagnosis, which “suggests that frailty can escalate rapidly,” according to the study, which was published in the American Journal of Gastroenterology.
“The biggest take away for celiac disease patients is to recognize the importance of follow-up with their gastroenterologist and dietitian to make sure nutritional deficiencies and comorbid conditions are addressed,” said Haley Zylberberg, MD, lead study author and a gastroenterologist with Weill Cornell Medicine. “Frequently people are told to just follow the gluten-free diet and that’s it, but this study highlights the need for closer monitoring especially in older adults.”
Healing of the intestine in study participants with celiac disease did not protect them from becoming frail in the future, according to analysis done by Zylberberg and researchers from seven institutions in the United States, Sweden and Finland.
Frailty was defined as increased vulnerability to negative health conditions associated with aging, with a higher risk of dementia, falls and increased hospitalizations. Frail older adults are also at increased risk of death that could be delayed if frailty could be prevented, the study says.
Frailty is recognized as a public health burden, with a need for more awareness and interventions as the population ages, a 2019 international study found.
“Identification of patients who are frail or at risk of frailty may lead to physical, social and lifestyles interventions that may mitigate geriatric syndromes and other health risks,” the study says.
The celiac disease study was based on a national Swedish patient registry that included about 4,600 older patients diagnosed with celiac disease from 2004 to 2017 who were matched to about 22,000 controls who did not have the condition.
Of the celiac disease patients, about 54 percent had health records that indicated frailty up to three years before diagnosis compared to about 20 percent of controls who had signs of frailty in the previous three years.
Similarly, about 54 percent of the 2,000 patients with celiac disease without frailty before diagnosis had frailty in the five years after diagnosis compared to about 41 percent of about 7,000 controls in the same time period. That put those with celiac disease at a 61 percent increased risk compared to their peers.
Women with celiac disease were particularly at risk for developing frailty, with an almost 200 percent increased risk compared to their peers.
The risk of frailty at the start of the study was similar between celiac disease patients whose biopsies showed intestinal healing and those whose showed persistent intestinal damage. Future risk of frailty at five years among those who did not show initial signs of frailty was also similar regardless of whether the intestine showed healing or not.
This analysis was done because persistent intestinal damage is associated with poorer health in those with celiac disease and is also more common in older adults, the study says.
Although the study did not assess the nutritional status of celiac disease patients, the authors note that malnutrition may have been a cause of frailty. They suggest this might stem from poor nutritional counseling for older adults who need to adapt to a gluten-free diet later in life. Struggles with maintaining a gluten-free diet might also lead to the increased risk of ongoing damage to the intestine, the authors suggest.
Siblings of celiac disease patients in the study were included as a secondary comparison group to enable researchers to control for genetic and environmental factors that are likely to be similar among family members and which might also contribute to frailty. About 800 celiac disease patients and about 1,200 siblings were included in this analysis, which found that the celiac disease patients have increased risk of frailty compared to their brothers or sisters.
Physicians treating older celiac disease patients also have something to learn from the study results, Zylberberg noted. “The biggest take aways for clinicians are to first think about making the diagnosis of celiac disease in older adults,” she said. “Second they should think about how to integrate concepts of geriatric medicine into gastroenterology care more broadly.”
You can read more about the study here.
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