Perception of following gluten-free diet and adherence to treatment in pediatric patients with celiac disease

Abstract

Introduction: Celiac disease (CD) is a chronic immune-mediated enteropathy present in ~1% of population. Gluten-free diet (GFD) is the only treatment for this condition and the main limitation of its efficacy is the lack of adherence.

Objective: To assess factors influencing adherence to GFD in pediatric patients and measure the concordance between serological results and a nutritional adherence questionnaire.

Patients and Methods: celiac patients younger than 18 years of age, diagnosed CD following ESPGHAN criteria, on GFD for at least 6 months and consulting at Hospital Roberto
del Río, Santiago, in 2008-2016, were assessed. Clinical presentation, nutritional evaluation and factors related to adherence to treatment (diet) were registered. A subsample answered Biaggi´s nutritional questionnaire.

Results: Of 65 evaluated patients, 44% and 30,1% adhered to GFD according to
blood autoantibodies (TTG and EMA) and the adherence questionnaire, respectively. “Age at debut” (p = 0.049), “perception of following GFD correctly” (p = 0.002) and “behavior in social events” (p = 0.005) were significantly associated with adherence to GFD. There was concordance between serological test and Biagi’s questionnaire (p = 0.0001).

Discussion: Adherence to GFD was lower than reported in literature. Intervention of some of the identified variables associated with adherence may help improving follow-up of celiac patients, especially those that due to diverse situations cannot measure their antibodies periodically.