Older Adults With Celiac Disease Face Greater Risk of Frailty: Insights From a Nationwide Study

Celiac.com 01/03/2025 - Celiac disease, a chronic immune-mediated condition triggered by gluten consumption, has historically been associated with gastrointestinal symptoms. However, as diagnostic methods improve, the disease is increasingly identified in older adults. While celiac disease in younger populations has been studied extensively, limited research has explored its long-term complications in older individuals. Frailty—a state of increased vulnerability to adverse health outcomes—is a critical concern in aging populations. This study aimed to evaluate the relationship between celiac disease and frailty in adults aged 60 years and older, using a large nationwide cohort in Sweden.

Research Methods

The study utilized Swedish national health records to identify adults aged 60 and older who were newly diagnosed with celiac disease between 2004 and 2017. Each individual with celiac disease was matched to population-based controls without the disease, ensuring comparability by age, sex, location, and calendar year. The primary analysis focused on baseline frailty within three years before the diagnosis of celiac disease or the corresponding index date for controls. Frailty was assessed using the Hospital Frailty Risk Score, a validated tool that categorizes individuals into low, intermediate, and high-risk frailty levels. Among those without frailty at baseline, the researchers assessed the likelihood of developing frailty over a five-year period. Additionally, they investigated whether achieving mucosal healing—evidence of intestinal recovery—on follow-up biopsies influenced the risk of future frailty.

Key Findings

Baseline Frailty Before Diagnosis

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The analysis included 4,646 older adults with celiac disease and 21,944 matched controls. Frailty at baseline was significantly more common among individuals with celiac disease compared to controls, with 54.4% of celiac disease patients exhibiting frailty versus 29.7% of controls. This pattern held true across all frailty categories:

• Low-risk frailty: 43.4% in celiac patients versus 23.8% in controls.
• Intermediate-risk frailty: 10.3% in celiac patients versus 5.4% in controls.
• High-risk frailty: 0.8% in celiac patients versus 0.6% in controls.

Increased Risk of Frailty Over Time

Among individuals without frailty at baseline, those with celiac disease had a 61% higher risk of developing frailty within five years compared to their matched counterparts. This heightened risk was consistent across the study population, highlighting the sustained vulnerability associated with celiac disease even after initial diagnosis.

Impact of Mucosal Healing

The study also explored whether achieving mucosal healing, as confirmed by follow-up intestinal biopsies, reduced the likelihood of frailty in celiac disease patients. Interestingly, no protective effect was observed. Whether or not individuals showed evidence of intestinal recovery, their risk of frailty remained elevated compared to the general population. This finding suggests that factors beyond intestinal inflammation, such as systemic inflammation or nutritional deficiencies, may contribute to the development of frailty in celiac disease.

Discussion

The results of this study underscore the significant impact celiac disease can have on overall health and well-being, particularly in older adults. Even before diagnosis, individuals with celiac disease were more likely to exhibit signs of frailty, which may be linked to long-standing nutritional deficiencies, chronic inflammation, or undiagnosed symptoms. Post-diagnosis, the heightened risk of frailty persisted, indicating that managing celiac disease with a strict gluten-free diet may not fully mitigate its broader health effects.

The lack of a protective benefit from mucosal healing is particularly noteworthy. While intestinal recovery is often considered a marker of successful treatment in celiac disease, this study suggests that it may not be sufficient to address all systemic risks. This finding highlights the need for comprehensive management strategies that extend beyond diet to address factors like bone health, muscle strength, and overall resilience.

Conclusion and Implications

This study provides compelling evidence that older adults with celiac disease face a significantly higher risk of frailty compared to their peers without the condition. Frailty, in turn, is associated with greater susceptibility to adverse health outcomes, including falls, hospitalizations, and decreased quality of life. These findings emphasize the importance of early diagnosis and proactive management of celiac disease in older adults to mitigate its long-term impacts.

For individuals with celiac disease, the study highlights the need for holistic care approaches that go beyond a gluten-free diet. Regular assessments of nutritional status, bone density, and physical function may help reduce the risk of frailty and improve overall health outcomes. By shedding light on the broader implications of celiac disease, this research underscores the importance of tailored care strategies for aging populations affected by the condition.

Read more at: journals.lww.com