Andy
Senior Member (Voting rights)
ABSTRACT
Background
Noncoeliac gluten sensitivity (NCGS) remains a controversial clinical entity at the intersection between disorders of gut–brain interaction (DGBI) and disordered eating. We aimed to determine the prevalence of self-reported NCGS and to characterise its association with DGBI and avoidant/restrictive food intake disorder (ARFID) symptoms in an adult general population.
Methods
We conducted a population-based internet survey with pre-defined demographic quotas across the United States of America and United Kingdom in 2023. Participants completed the Rome IV diagnostic questionnaire, the Nine-Item ARFID screen, and validated instruments for psychological distress, somatisation and quality of life.
Results
A total of 4002 participants (50% female; median age 46 years) were included in the analyses. The prevalence of NCGS was 14.2% (95% CI, 13.1–15.3). Participants with self-reported NCGS reported more nongluten food intolerances than those without self-reported NCGS (median 3 vs. 0, p < 0.001). Among individuals with NCGS, 69.4% (95% CI, 65.4–73.1) had concomitant DGBI and/or ARFID symptoms, with nearly one-quarter (24.0%; 95% CI, 20.6–27.8) meeting the criteria for all three conditions. Those with comorbid self-reported NCGS, DGBI and ARFID symptoms had the highest levels of psychological distress, somatic symptom reporting, increased healthcare utilisation and reduced quality of life (all p < 0.001).
Conclusion
NCGS is reported by approximately one in seven adults in the United States of America and United Kingdom. Individuals with self-reported NCGS frequently meet diagnostic criteria for DGBI and/or ARFID symptoms, and those who experience all three entities represent a distinct high-severity phenotype. Our findings suggest that self-reported NCGS may represent a broader syndrome of food-related symptom attribution rather than gluten-specific pathology.
Key Summary
What is the established knowledge on this subject?
What are the significant and/or new findings of this study?
Background
Noncoeliac gluten sensitivity (NCGS) remains a controversial clinical entity at the intersection between disorders of gut–brain interaction (DGBI) and disordered eating. We aimed to determine the prevalence of self-reported NCGS and to characterise its association with DGBI and avoidant/restrictive food intake disorder (ARFID) symptoms in an adult general population.
Methods
We conducted a population-based internet survey with pre-defined demographic quotas across the United States of America and United Kingdom in 2023. Participants completed the Rome IV diagnostic questionnaire, the Nine-Item ARFID screen, and validated instruments for psychological distress, somatisation and quality of life.
Results
A total of 4002 participants (50% female; median age 46 years) were included in the analyses. The prevalence of NCGS was 14.2% (95% CI, 13.1–15.3). Participants with self-reported NCGS reported more nongluten food intolerances than those without self-reported NCGS (median 3 vs. 0, p < 0.001). Among individuals with NCGS, 69.4% (95% CI, 65.4–73.1) had concomitant DGBI and/or ARFID symptoms, with nearly one-quarter (24.0%; 95% CI, 20.6–27.8) meeting the criteria for all three conditions. Those with comorbid self-reported NCGS, DGBI and ARFID symptoms had the highest levels of psychological distress, somatic symptom reporting, increased healthcare utilisation and reduced quality of life (all p < 0.001).
Conclusion
NCGS is reported by approximately one in seven adults in the United States of America and United Kingdom. Individuals with self-reported NCGS frequently meet diagnostic criteria for DGBI and/or ARFID symptoms, and those who experience all three entities represent a distinct high-severity phenotype. Our findings suggest that self-reported NCGS may represent a broader syndrome of food-related symptom attribution rather than gluten-specific pathology.
Key Summary
What is the established knowledge on this subject?
- Noncoeliac gluten sensitivity (NCGS) is a condition characterised by gastrointestinal and extra-intestinal symptoms following gluten ingestion in individuals without coeliac disease.
- It is currently unclear whether NCGS represents a specific food hypersensitivity or a more heterogeneous entity driven by overlapping disorders of gut-brain interaction (DGBI) and disordered eating, such as avoidant/restrictive food intake disorder (ARFID).
What are the significant and/or new findings of this study?
- This study provides the first large-scale evaluation of the epidemiology and clinical associations of self-reported NCGS using a rigorous, standardised methodology across the United States of America and United Kingdom.
- NCGS is reported by 14.2% of adults in the United States of America and United Kingdom. Self-reported NCGS is strongly associated with DGBI across all gastrointestinal regions and with concurrent ARFID symptoms.
- The burden of these overlapping comorbidities is the primary driver of symptom severity, psychological distress, healthcare utilisation and impaired quality of life.
- Most individuals with self-reported NCGS report adverse reactions to multiple nongluten foods and do not follow a gluten-free diet.