Sub-clinical eating behaviours in Celiac disease: a scoping review

Abstract: Objectives: Coeliac disease (CeD) is an autoimmune disorder caused by the ingestion of the gluten allergen, leading to damage to the small intestine and nutrient malabsorption. Currently, the only safe treatment is the gluten-free diet (GFD), whose dietary restrictions may affect people with CeD (PwCeD)’s relationship with food and increase the risk of subclinical eating behaviours. This scoping review aimed to identify the presence and diversity of subclinical eating behaviours among PwCeD. Design: The scoping review observed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies, with two independent reviewers conducting all the phases of the review. Data sources: Eligible articles were retrieved from the following databases from inception to September 2025: PubMed (NCBI platform), Psycinfo (APA PsycNet), Web of Science (Clarivate), Scopus (Elsevier), Cochrane Library (Wiley). Eligibility criteria: English, peer-reviewed full-text papers regarding quantitative studies focusing on PwCeD and subclinical eating behaviours that do not reach significance for a full eating disorder diagnosis were included in the present review. Studies involving individuals with non-coeliac gluten sensitivity, qualitative designs, reviews, grey literature and non-English publications were excluded. Data extraction and synthesis: The main outcomes involved eating behaviours that did not reach significance for a full eating disorder diagnosis and that might be related to emotional regulation. Results: From 1805 records, 13 predominantly cross-sectional studies met inclusion criteria involving 3724 subjects in total. Participants were predominantly female (M: 595/F: 3129; age: 35.14±8.37, BMI: 22.50±2.48), mostly referring to a moderate adherence towards GFD. The identified subclinical eating behaviours included: maladaptive eating attitudes, disordered eating, food insecurity, hypervigilance and body dissatisfaction. In addition, nine studies investigated their associations with GFD, quality of life (QoL), social anxiety and psychiatric comorbidities. Conclusion: Subclinical disordered eating behaviours may impair QoL, mental health and adherence to GFD in PwCeD. Further studies are needed to enhance patients’ psychological state.