Gluten-Free Diet Adherence In Celiac Versus Non-Celiac American Adults

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16th International Coeliac Disease Symposium P-059

Smith J
California State University Northridge, USA

Background & aims: The rising number of individuals in the US following a gluten-free diet prior to undergoing testing for celiac disease precludes them from obtaining an accurate diagnosis. It is unknown if dietary compliance in these individuals is adequate to avoid the health-related outcomes of untreated celiac disease. This study will examine the degree of dietary adherence in various populations following the GFD and determine if there is any relationship between reason for following a GFD and level of diet adherence. Results will indicate the need or lack of thereof for efforts aimed at formal diagnosis of celiac disease.

Material & methods: Participants were recruited via American social media platforms. Included were those age 18 and older, living in the United States, and who agreed that they follow a gluten-free diet, where gluten means “the protein component of wheat, barley and rye” (n=357). They completed an online self-questionnaire regarding the frequency of GFD behaviors. Nine items on the questionnaire were validated by previous studies to be clinically sensitive indicators of dietary compliance in those with celiac disease. Questionnaire score was calculated based on the criteria used by each study. Participants were divided into cohorts based on their reason for initiating the diet: diagnosis of celiac disease (n=173); gluten sensitivity / intolerance / allergy (n=146); weight loss (n=4); other health-related reason (n=29); other non-health-related reason (n=5). Groups were controlled for gender, duration following the gluten-free diet, and severity of symptoms experienced from gluten ingestions. ANCOVA means test was used to determine if there was a significant difference in diet adherence score between groups. Chi square test was used to determine significant differences in responses on questions that were not included in the overall diet adherence score.

Results: A total of 324 individuals who participated in the study met inclusion criteria, and were included in data analysis. 139 self-identified as diagnosed with celiac disease or dermatitis herpetiformis, 141 self-identified as sensitive to gluten, and 46 self-identified as following the diet for some other health-related reason, such as to treat a different disorder.

Demographic Differences Between Groups. Significantly more women than men were following a GFD for a reason other than a diagnosis of celiac disease (47.3% and 16.9% of women vs. 26.6% and 3.1% of men, for gluten sensitivity and other health reason respectively). The most common reason that men were following a GFD was because of a diagnosis of celiac disease (70.3% of men). The majority of those following a GFD for five or more years were diagnosed with celiac disease (58.0%). The majority of respondents following a GFD for 6 months to 4 years, however, were sensitive to gluten (51.7%). The majority of respondents following a GFD for less than 6 months (42.3%) reported doing so for other health reasons.

Differences in Dietary Adherence Between Groups. Individuals diagnosed with celiac disease were found to have significantly higher dietary adherence than those following a GFD because of gluten sensitivity or another health-related reason as defined by the Biagi et al (2012) dietary adherence score (chi2 = 23.89, p = 0.002). The majority of all respondents however (70.2%) were considered highly adherent to a GFD (Biagi score of 3-4). 47.4% of the non-adherent group (score 0-1) cited gluten sensitivity as their reason for following a GFD, 25.0% cited other health reason, and 21.1% cited celiac disease.

Conclusion: Significant differences exist in the level of compliance to a GFD based on an individual’s reason for following the diet. Efforts need to focus on correctly diagnosing and disseminating accurate information to individuals who have a life-threatening need for following the GFD. Without a diagnosis of celiac disease, individuals are less likely to follow behaviors that are recommended for those with celiac disease.

Acknowledgements: Celiac Disease Foundation; Tricia Thompson, MS, RD; and Terri Lisagor, EdD, RD.