Characteristics of Inpatients With and Without Celiac Disease on a Gluten-Free Diet

Introduction: Most people who maintain a gluten-free diet (GFD) do not have celiac disease. Comorbidities and associated conditions in this population are largely unknown. We aimed to measure demographics, dietary patterns and diagnoses for patients prescribed a GFD during hospitalization and compare inpatients with celiac disease to those without celiac disease. Methods: We performed a retrospective case-control study of the electronic medical record for all hospital admissions at our institution in which a GFD was ordered between Jan 1, 2010 and June 30, 2022. We excluded patients missing demographic data (n=113). We compared characteristics of patients with vs without a celiac disease diagnosis. We performed multivariable logistic regression to identify characteristics independently associated with a celiac disease diagnosis. Results: We analyzed 1527 patients with a GFD. A minority (n= 467, 30.6%) of these patients carried a diagnosis of celiac disease. Age, sex, body mass index and Medicare/Medicaid enrollment were not significantly different between these groups. The celiac cohort was more predominantly white (66.6% vs 58.4%, P=0.007) and non-Hispanic (62.5% vs 52.7%, P=0.001). Rates of additional diagnoses associated with a GFD (e.g. irritable bowel syndrome) were not significantly different (Table 1). While hospitalized, patients with celiac disease had fewer additional dietary restrictions (mean 0.33 vs 0.56, P< 0.001) and more frequent micronutrient supplementation (26.6% vs 21.4%, P=0.03). Multivariable logistic regression of variables associated with celiac disease found an independent association with an ICD diagnosis of malnutrition (OR 1.86, 95% CI 1.31-2.65, P=0.001) and an inverse association with a vegetarian diet (OR 0.35, 95% CI 0.15-0.81, P=0.01), a reduced lactose diet (OR 0.25, 95% CI 0.13-0.50, P< 0.001) and Hispanic ethnicity (OR 0.56 95% CI 0.35-0.90, P=0.02) while controlling for other covariates. Conclusion: Two thirds of inpatients receiving a GFD do not have a diagnosis of celiac disease. Among GFD inpatients, celiac disease is independently associated with a diagnosis of malnutrition. This higher rate of malnutrition may signal improved recognition of malnutrition in the celiac disease population. Fewer inpatient dietary restrictions and higher rates of micronutrient supplementation may act as additional indicators of provider recognition of nutrition needs in celiac disease. Table 1. - Characteristics and Comorbidities of Patents with and without Celiac Disease Admitted to the Hospital and Prescribed a Gluten-Free Diet (GFD) Between January 1, 2010-June 30, 2022 Characteristic Celiac Patients (n=467) Non-Celiac GFD Patients (n=1060) P-value Age (years), n (%) Age < 20 83 (17.77%) 226 (21.32%) Age 20-39 136 (29.12%) 295 (27.83%) Age 40-59 99 (21.20%) 238 (22.45%) Age 60-79 110 (23.55%) 238 (22.45%) Age 80+ 39 (8.35%) 53 (5.94%) 0.25 Mean (IQR) 44.81 (38) 42.63 (39) 0.11 Sex, n (%) Female 312 (66.81%) 726 (68.49%) Male 155 (33.19%) 334 (31.51%) 0.52 Race, n (%) White 311 (66.60%) 619 (58.40%) Black 15 (3.21%) 55 (5.19%) Other/Unknown 141 (30.19%) 386 (36.42%) 0.007 Ethnicity, n (%) Non-Hispanic 292 (62.53%) 559 (52.74%) Hispanic 31 (6.64%) 102 (9.62%) Other/Unknown 144 (30.84%) 399 (37.64%) 0.001 BMI Category BMI < 18.5 Underweight 50 (10.71%) 152 (14.34%) BMI 18.5-24.9 Normal 154 (32.98%) 382 (36.04%) BMI 25-29.9 Overweight 92 (19.70%) 184 (17.36%) BMI >=30 Obese 49 (10.49%) 117 (11.04%) BMI Unknown 122 (26.12%) 225 (21.23%) 0.07 Mean (range) 24.30 (13.3-48.1) 23.90 (9.6-62.0) 0.33 Medicare/Medicaid Subscriber, n (%) 121 (25.91%) 257 (24.25%) 0.49 Diagnoses, n (%) Irritable Bowel Syndrome 27 (5.78%) 56 (5.28%) 0.69 Inflammatory Bowel Disease 19 (4.07%) 40 (3.77%) 0.78 Thyroid Disease 89 (19.06%) 187 (17.64%) 0.51 Systemic Lupus Erythematosus 13 (2.78%) 22 (2.08%) 0.39 Autism 2 (0.43%) 9 (0.85%) 0.52 Malnutrition 78 (16.70%) 107 (10.09%) < 0.001 Micronutrient Supplement Prescribed Inpatient, n (%) 124 (26.55%) 227 (21.42%) 0.03 Number of dietary restrictions ordered in medical record in addition to GFD, n (%) 0 326 (69.81%) 583 (55.00%) 1 127 (27.19%) 387 (36.51%) 2 13 (2.78%) 60 (5.66%) 3+ 1 (0.21%) 30 (2.83%) < 0.001 Mean (range) 0.33 (0-3) 0.56 (0-4) < 0.001 Diet Restriction by type, n (%) Fat Modified Diet 4 (0.86%) 7 (0.66%) 0.75 Diabetic Diet 25 (5.35%) 74 (6.98%) 0.23 Texture Modified Diet 25 (5.35%) 62 (5.85%) 0.70 Cardiac Diet 44 (9.42%) 123 (11.60%) 0.21 Fiber Modified Diet 20 (4.28%) 50 (4.72%) 0.71 Vegetarian Diet 14 (3.00%) 86 (8.11%) < 0.001 Reduced Lactose Diet 28 (6.00%) 219 (20.66%) < 0.001 Renal/Electrolyte Diet 4 (0.86%) 29 (2.74%) 0.02 Other 9 (1.93%) 23 (2.17%) 0.85