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Factors that Influence Adherence to a Gluten-Free Diet in Adults with Celiac Disease

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Abstract

Objective The only treatment for celiac disease is lifelong adherence to a gluten-free diet, yet adherence is limited and factors influencing adherence are poorly understood. The purpose of this study was to determine factors influencing gluten-free diet adherence in adults with celiac disease. Methods A questionnaire was developed and administered to 154 adults with celiac disease who then underwent a standardized gluten-free diet evaluation by an experienced nutritionist. Multivariate analysis was conducted to determine factors associated with adherence level. Results Thirteen factors hypothesized to contribute to gluten-free diet adherence were found to be significantly associated with improved adherence including: understanding of the gluten-free diet, membership of a celiac disease advocacy group, and perceived ability to maintain adherence despite travel or changes in mood or stress (P < 0.001). Conclusions This study identified specific factors correlated with gluten-free diet adherence. These results provide a foundation for the design of educational interventions to improve adherence.

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Abbreviations

BIDMC:

Beth Israel Deaconess Medical Center

CD:

Celiac disease

GCAS:

Global celiac assessment scale

GFD:

Gluten-free diet

tTG:

Tissue transglutaminase

References

  1. Dieterich W, Esslinger B, Schuppan D (2003) Pathomechanisms in celiac disease. Int Arch Allergy Immunol 132:98–108

    Article  PubMed  CAS  Google Scholar 

  2. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 163:286–292

    Article  PubMed  Google Scholar 

  3. Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu G, Fasano A (1998) Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 33:494–498

    Article  PubMed  CAS  Google Scholar 

  4. Catassi C, Fabiani E, Ratsch IM, Coppa GV, Giorgi PL, Pierdomenico R, Alessandrini S, Iwanejko G, Domenici R, Mei E, Miano A, Marani M, Bottaro G, Spina M, Dotti M, Montanelli A, Barbato M, Viola F, Lazzari R, Vallini M, Guariso G, Plebani M, Cataldo F, Traverso G, Ventura A et al (1996) The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects. Acta Paediatr Suppl 412:29–35

    Article  PubMed  CAS  Google Scholar 

  5. Maki M, Mustalahti K, Kokkonen J, Kulmala P, Haapalahti M, Karttunen T, Ilonen J, Laurila K, Dahlbom I, Hansson T, Hopfl P, Knip M (2003) Prevalence of Celiac disease among children in Finland. N Engl J Med 348:2517–2524

    Article  PubMed  Google Scholar 

  6. Accomando S, Cataldo F (2004) The global village of celiac disease. Dig Liver Dis 36:492–498

    Article  PubMed  CAS  Google Scholar 

  7. West J, Logan RF, Smith CJ, Hubbard RB, Card TR (2004) Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 329:716–719

    Article  PubMed  Google Scholar 

  8. Corrao G, Corazza GR, Bagnardi V, Brusco G, Ciacci C, Cottone M, Sategna Guidetti C, Usai P, Cesari P, Pelli MA, Loperfido S, Volta U, Calabro A, Certo M (2001) Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet 358:356–361

    Article  PubMed  CAS  Google Scholar 

  9. Tau C, Mautalen C, De Rosa S, Roca A, Valenzuela X (2006) Bone mineral density in children with celiac disease. Effect of a Gluten-free diet. Eur J Clin Nutr 60:358–363

    Article  PubMed  CAS  Google Scholar 

  10. Dewar DH, Ciclitira PJ (2005) Clinical features and diagnosis of celiac disease. Gastroenterology 128:S19–S24

    Article  PubMed  Google Scholar 

  11. Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI (2003) Risk of malignancy in patients with celiac disease. Am J Med 115:191–195

    Article  PubMed  Google Scholar 

  12. Zarkadas M, Cranney A, Case S, Molloy M, Switzer C, Graham ID, Butzner JD, Rashid M, Warren RE, Burrows V (2006) The impact of a gluten-free diet on adults with coeliac disease: results of a national survey. J Hum Nutr Diet 19:41–49

    Article  PubMed  CAS  Google Scholar 

  13. Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M (2002) Gluten-free diet and quality of life in patients with screen-detected celiac disease. Eff Clin Pract 5:105–113

    PubMed  Google Scholar 

  14. Pynnonen PA, Isometsa ET, Verkasalo MA, Kahkonen SA, Sipila I, Savilahti E, Aalberg VA (2005) Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. BMC Psychiatry 5:14

    Article  PubMed  CAS  Google Scholar 

  15. Addolorato G, Capristo E, Ghittoni G, Valeri C, Masciana R, Ancona C, Gasbarrini G (2001) Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scand J Gastroenterol 36:502–506

    Article  PubMed  CAS  Google Scholar 

  16. Hogberg L, Grodzinsky E, Stenhammar L (2003) Better dietary compliance in patients with coeliac disease diagnosed in early childhood. Scand J Gastroenterol 38:751–754

    Article  PubMed  CAS  Google Scholar 

  17. Ciacci C, Cirillo M, Cavallaro R, Mazzacca G (2002) Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion 66:178–185

    Article  PubMed  CAS  Google Scholar 

  18. Van Meensel B, Hiele M, Hoffman I, Vermeire S, Rutgeerts P, Geboes K, Bossuyt X (2004) Diagnostic accuracy of ten second-generation (human) tissue transglutaminase antibody assays in celiac disease. Clin Chem 50:2125–2135

    Article  PubMed  CAS  Google Scholar 

  19. Ciacci C, D’Agate C, De Rosa A, Franzese C, Errichiello S, Gasperi V, Pardi A, Quagliata D, Visentini S, Greco L (2003) Self-rated quality of life in celiac disease. Dig Dis Sci 48:2216–2220

    Article  PubMed  CAS  Google Scholar 

  20. Pietzak MM (2005) Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology 128:S135–S141

    Article  PubMed  Google Scholar 

  21. Mayer M, Greco L, Troncone R, Auricchio S, Marsh MN (1991) Compliance of adolescents with coeliac disease with a gluten free diet. Gut 32:881–885

    Article  PubMed  CAS  Google Scholar 

  22. Fabiani E, Catassi C, Villari A, Gismondi P, Pierdomenico R, Ratsch IM, Coppa GV, Giorgi PL (1996) Dietary compliance in screening-detected coeliac disease adolescents. Acta Paediatr Suppl 412:65–67

    Article  PubMed  CAS  Google Scholar 

  23. Fabiani E, Taccari LM, Ratsch IM, Di Giuseppe S, Coppa GV, Catassi C (2000) Compliance with gluten-free diet in adolescents with screening-detected celiac disease: a 5-year follow-up study. J Pediatr 136:841–843

    Article  PubMed  CAS  Google Scholar 

  24. Kumar PJ, Walker-Smith J, Milla P, Harris G, Colyer J, Halliday R (1988) The teenage coeliac: follow up study of 102 patients. Arch Dis Child 63:916–920

    PubMed  CAS  Google Scholar 

  25. Bardella MT, Molteni N, Prampolini L, Giunta AM, Baldassarri AR, Morganti D, Bianchi PA (1994) Need for follow up in coeliac disease. Arch Dis Child 70:211–213

    Article  PubMed  CAS  Google Scholar 

  26. Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD (2005) Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 116:e754–e759

    Article  PubMed  Google Scholar 

  27. Vahedi K, Mascart F, Mary JY, Laberenne JE, Bouhnik Y, Morin MC, Ocmant A, Velly C, Colombel JF, Matuchansky C (2003) Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. Am J Gastroenterol 98:1079–1087

    Article  PubMed  CAS  Google Scholar 

  28. Peters U, Askling J, Gridley G, Ekbom A, Linet M (2003) Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med 163:1566–1572

    Article  PubMed  Google Scholar 

  29. Sheiner E, Peleg R, Levy A (2006) Pregnancy outcome of patients with known celiac disease. Eur J Obstet Gynecol Reprod Biol 129(1):41–45

    Article  PubMed  Google Scholar 

  30. Cranney A, Zarkadas M, Graham ID, Switzer C (2003) The Canadian celiac health survey—the Ottawa chapter pilot. BMC Gastroenterol 3:8

    Article  PubMed  Google Scholar 

  31. Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, McMahon DJ, Absan H, Neugut AI (2001) Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 96:126–131

    Article  PubMed  Google Scholar 

  32. Fera T, Cascio B, Angelini G, Martini S, Guidetti CS (2003) Affective disorders and quality of life in adult coeliac disease patients on a gluten-free diet. Eur J Gastroenterol Hepatol 15:1287–1292

    Article  PubMed  Google Scholar 

  33. Lee SK, Lo W, Memeo L, Rotterdam H, Green PH (2003) Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc 57:187–191

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was supported by charitable donations to the Celiac Center at BIDMC, the Celiac Sprue Association, NIH T32 training grant DK07760, and the Harvard-Thorndike General Clinical Research Center M01 RR01032.

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Authors and Affiliations

  1. Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA

    Daniel A. Leffler, Jessica Edwards-George, Melinda Dennis, Detlef Schuppan & Ciaran P. Kelly

  2. Department of Psychology, Northeastern University, Boston, MA, USA

    Jessica Edwards-George, Debra L. Franko & Jessica Blom-Hoffman

  3. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Francis Cook

Authors
  1. Daniel A. Leffler
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  2. Jessica Edwards-George
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  3. Melinda Dennis
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  4. Detlef Schuppan
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  5. Francis Cook
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  6. Debra L. Franko
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  7. Jessica Blom-Hoffman
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  8. Ciaran P. Kelly
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Corresponding author

Correspondence to Daniel A. Leffler.

Appendices

Appendices

Appendix 1 Expert dietitian evaluation of gluten-free diet adherence
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Appendix 2 Gluten-free diet knowledge quiz
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Leffler, D.A., Edwards-George, J., Dennis, M. et al. Factors that Influence Adherence to a Gluten-Free Diet in Adults with Celiac Disease. Dig Dis Sci 53, 1573–1581 (2008). https://doi.org/10.1007/s10620-007-0055-3

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  • DOI: https://doi.org/10.1007/s10620-007-0055-3

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