title: Fatigue as a determinant of health in patients with celiac disease.
abstract: BACKGROUND
  Symptoms of uncontrolled celiac disease impair patients' health-related quality of life, which improves with the exclusion of gluten from the diet. A symptom frequently reported, but difficult to make objective, is fatigue. The Daily Fatigue Impact Scale (D-FIS) questionnaire consisting of 8 items, each scored on a 0 to 4 point scale, with lower scores reflecting greater fatigue, was employed to measure fatigue in celiac patients.
  
  
  OBJECTIVE
  To assess the influence of fatigue on perception of health in celiac disease patients determined as their quality of life.
  
  
  METHODS
  Prospective, cross-sectional study in celiac disease patients diagnosed by serology and histology. Instruments used were the D-FIS to measure fatigue and the generic EuroQol5D to measure quality of life. An additional question on the frequency of problems due to fatigue, scored on a 7-point Likert scale, was used to evaluate the importance of fatigue. RESULTS (IN MEDIANS): In all, 51 patients were included (13 untreated and 38 treated with a gluten-free diet). D-FIS score was significantly worse in untreated celiacs (16.0 vs. 3.0, P<0.001). Scores on the frequency scale of fatigue-related problems were also worse in untreated celiacs (2.0 vs. 6.0, P<0.001). Fatigue and quality-of-life scores were inversely correlated (r=-0.6, P<0.001). Fatigue severity was also greater in patients with worse quality of life (13.0 vs. 2.0, P<0.01). Multiple regression analysis showed fatigue to be an independent determinant of quality of life.
  
  
  CONCLUSIONS
  Fatigue is a major concern in untreated celiac disease patients, which impacts their quality of life.
authors.affiliation: Digestive System Research Unit, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain. fcasellas@vhebron.net
authors.forename: Francesc Casellas
authors.initials: FC
authors.lastname: Jordá
authors.forename: Josefa
authors.initials: J
authors.lastname: López Vivancos
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires