Theses and Dissertations


Issuing Body

Mississippi State University


Tolar-Peterson, Terezie

Committee Member

Cheng, Wen- Hsing

Committee Member

Wei, Tianlan

Committee Member

Tidwell, Diane K

Committee Member

Conard, Amanda

Other Advisors or Committee Members

Zhang, Jialin

Date of Degree


Document Type

Dissertation - Open Access



Degree Name

Doctor of Philosophy (Ph.D)


College of Agriculture and Life Sciences


Department of Food Science, Nutrition and Health Promotion


Celiac disease (CD), an autoimmune disorder affecting millions of Americans, poses significant obstacles leading to a normal life. With no known cure, adherence to a strict glutenfree diet (GFD) is essential. However, the cost and limited availability of gluten-free alternatives can burden individuals with CD. Additionally, factors such as socioeconomic status, nutrient deficiencies, and the nature of the disease may contribute to mental health issues. This study aimed to investigate the influence of adherence to a GFD on depression in CD patients. The prevalence of depression among individuals with CD from diverse backgrounds was examined, along with the analysis of macro- and micronutrient distribution and the impact of the GFD. Data from the National Health and Nutrition Examination Survey spanning three cycles (2009-2014) were extracted, including 70 CD patients and 271 participants reporting general gluten issues. The dataset was analyzed using SAS v9.4 (SAS Institute, Inc., Cary, NC) with the three cycles merged using a unique identifier sequential number. Sample weights were applied to mitigate bias in national estimates due to unequal probability of selection, while oversampling was utilized to enhance the study’s reliability when examining subgroups or minorities. Survey weight and sampling design considerations were incorporated into the SAS syntax to safeguard participants’ privacy, as managed by the National Center for Health Statistics. Multiple linear regression analysis revealed no significant association between depression and adherence to the GFD or CD; however, ethnicity showed significance. Celiac disease exhibited a prevalence of 0.12% among White individuals, 3-6 times higher than other ethnic groups, and was twice as prevalent in females compared to males. Notably, deficiencies in macro- and micronutrients among CD and GFD cases were observed. Carbohydrate intake exhibited a negative association with GFD consumers and those with CD, while individuals adhering to a GFD showed an association with decreased polyunsaturated fat consumption, yet within adequate intakes. Deficiencies in micronutrients such as thiamin, vitamins B12, D, and E, and calcium were also observed within GFD group, while a low sodium intake was observed among CD group. This study provides insights into the complex interplay between diet, mental health, and CD management.