Introduction A gluten-free diet (GFD) is the mainstay of treatment in Coeliac Disease. The impact of this restrictive diet on the quality of life (QoL) of the Coeliac individual is uncertain and debated. These uncertainties may stem from focusing on the level of dietary adherence rather than the difficulties faced to achieve adherence. We hypothesised that the more difficult the individual perceives following a GFD, the lower their QoL will be as a result.

Methods Postal survey (n=573) of histologically proven Coeliac individuals (n=225) and non-health seeking age and sex matched controls (n=348). Questionnaire included the MOS Short-Form 36-Item (SF-36) QoL measure, The Hospital Anxiety and Depression Scale (HADS) and an assessment of GFD adherence, lifestyle obstacles encountered following the diet and perceived degree of difficulty following a GFD.

Results Around two-thirds of the Coeliac group reported full GFD adherence (always: 64.6%; mostly: 24.8%; sometimes: 6.6% and rarely/never: 4%). Very little difference was observed in SF-36 or HADS scores when comparing “always” adherent individuals to partial/none adherent (p=ns). Many reported lifestyle obstacles following the diet: eating out (88%), at work (27%), at home (12%), travelling (73%), personal relationships (13%) and socialising (71%). Despite the level of GFD adherence most Coeliac individuals reported difficulty with the GFD: no difficulty (20%), difficult sometimes (61%), difficult mostly (14%) and impossible (5%). Stepwise reductions in QoL were observed in the Coeliac group based on the increasing level of GFD difficulty reported. Mental/psychological aspects of QoL were particularly reduced (p=<0.0001). 'Mostly difficult' was associated with possible anxiety and probable depression based on median HADS scores (p=<0.0001) (Abstract 084).

Conclusion Comparing our Coeliac group based on adherence level alone would have revealed very little difference in QoL suggesting the GFD has a negligible impact on patient wellbeing. However, group comparison based on difficulty level reveals significant differences and a high likelihood of anxiety and depression associated with the highest degrees of difficulty. We contend that future research must consider adherence in the context of difficulty if a more informed appreciation of the impact this diet has on Coeliac individuals is to be achieved.