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Woman diagnosed with celiac disease may be more likely to face a secondary diagnosis of anorexia nervosa, researchers suggest, after a nationwide study discovered a potential link between the two.

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“Before this study, there have been published a few small ‘case reports’ of patients with celiac disease developing eating disturbances after their celiac disease diagnosis,” lead study author Dr. Karl Marild, a researcher at the University of Colorado in Aurora, told Reuters. “This however is the first large study to show an association between celiac disease and anorexia nervosa.”

Anorexia nervosia is an emotional disorder that involves an obsessive desire to lose weight by refusing to eat, Reuters reported. The disorder can share similar symptoms to celiac disease, which is an autoimmune disorder in which consumption of gluten leads to damage of the small intestine and problems with absorption of nutrients.

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For the study, published April 3 in the journal Pediatrics, researchers examined data collected from 1987 through 2009 on almost 18,000 Swedish women diagnosed with celiac disease, and approximately 89,000 women who did not have an autoimmune disorder, Reuters reported.

From the data, researchers found that after a celiac disease, women were 46 percent more likely to be diagnosed with anorexia nervosa. Additionally, those diagnosed with anorexia nervosa had twice the odds of a later diagnosis of celiac disease.

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The authors noted that the study wasn’t meant to prove that celiac disease causes anorexia, or the opposite, and that it is possible that some patients were initially misdiagnosed with one disease when they had the other. Marild also told Reuters that dietary restrictions after a celiac disease diagnosis may trigger an obsessive eating pattern that could lead to anorexia.

“Both celiac disease and anorexia nervosa may have similar symptoms: abdominal discomfort after eating, a feeling of fullness, changes in bowel habits and weight loss,” Dr. Neville Golden, an adolescent medicine researcher at Stanford Children’s Health in California, said, according to Reuters. “So the correct diagnosis may not always be clear.”

Reuters contributed to this report.