Predictors of Compliance to Gluten-Free Diet in Children with Celiac Disease

Background: Celiac disease (CD) is a common autoimmune disorder that presents intestinal and extra-intestinal symptoms. It is also associated with cardiovascular diseases and malignancies, and mortality risk. The only way to control the disease is to follow a strict gluten-free diet (GFD) for the rest of life. Objectives: This survey aimed to investigate GFD non-adherence and causes in the pediatric setting. Methods: In this study, 187 children aged between 2.5 to 14 years old with a confirmed diagnosis of CD at least for a year were studied using a questionnaire-based interview in a census study between 2018 to 2019 in a referral center in southern Iran. Results: About 40% of children adhered to a GFD poorly. This group significantly complained of more symptoms than the group with high adherence. Improper access was the most important cause of non-adherence to a GFD. The mean current weight and at the time of diagnosis as well as the mean current BMI and at the time of diagnosis in the non-adherent group were significantly lower than the adherent group. However, IgA anti-transglutaminase antibodies and histopathologic examination did not change remarkably. Furthermore, no significant relationship was found between following a GFD and age, age at the time of diagnosis, gender, and parental educational status. Conclusions: According to our results, inaccessibility, high costs, and lack of food labeling were the primary reasons for nonadherence to GDF. Therefore, to increase compliance, easy access to GFD with proper food labeling and suitable price should be implemented.

Automated summary

This study investigates the adherence to gluten-free diet (GFD) among pediatric patients with celiac disease (CD), as well as the reasons for non-adherence. The study finds that about 40% of children poorly adhere to GFD and experience more severe symptoms compared to the adherent group. Improper access to suitable food is identified as the primary cause of non-adherence. The non-adherent group has significantly lower weight and BMI than the adherent group, but there are no remarkable changes in anti-transglutaminase antibodies and histopathologic examination. There is also no significant relationship between adherence to GFD and age, age at diagnosis, gender, and parental educational status.