Adherence and non-adherence to a gluten-free diet (GFD) may impact negatively on health-related quality of life (HRQoL). Understanding the factors that influence compliance could help inform management and also guide support. With a particular focus on adolescence, this narrative review critiques current literature on the burdens associated with following a GFD and the factors associated with adherence. Studies highlight a variety of burdens faced by individuals with coeliac disease, including the cost, access and availability of gluten-free (GF) foods, as well as the dilemmas experienced when eating out, travelling and socialising with friends. A number of studies report that adolescents face stigmatisation and feel isolated in social situations and at school. Additional burdens that are highlighted are a lack of knowledge regarding CD and GFD difficulties in interpreting food labels, as well as dissatisfaction with the organoleptic properties of GF foods. Factors associated with poor adherence in adolescence include older age, an absence of immediate symptoms, difficulties eating out and poor palatability of GF foods. Conversely, better emotional support and stronger organisation skills have been associated with superior adherence. Significant associations have been reported between HRQoL measures and adherence, although the findings are inconsistent. Limitations in research methodologies exist and data are restricted to just a few countries. Further research specific to adolescence is required to identify independent predictors of adherence.

The prevalence of vitamin D deficiency in the United Kingdom is high, despite updated Scientific Advisory Committee on Nutrition (SACN) guidelines. Therefore, our aims were to identify population knowledge, attitudes and perceptions of vitamin D supplementation and factors contributing to supplement use in a UK adult population. A cross-sectional study was performed between April–June 2018 using a newly designed piloted questionnaire. Scores for knowledge were calculated as a percentage (Boland et al. 2015). Logistic regression analysis was used to predict supplement use. 209 participants (82% female), mean (±SD) age 34.9 (±12.3) completed the questionnaire. The mean (±SD) vitamin D knowledge score was 56.6% (±19.9%); only 48% were concerned about their vitamin D concentration and 57% did not take vitamin D. Most participants (86%) wished to learn more about vitamin D. Knowledge score (OR 2.5; p = 0.01; 95% CI 1.2–5.3), concern (OR 2.1; p = 0.03; 95% CI 1.0–4.2) and location (OR 0.3; p = 0.006; 95% CI 0.1–0.7) predicted supplemented use. Individuals living in England had 2.9 (95% CI 1.4–6.3) lower odds of taking vitamin D than those living in Scotland. As a result of these findings, this study suggests that vitamin D supplementation and fortification, alongside education strategies, may be an effective method for improving UK vitamin D health; however, more research is warranted.

BACKGROUND AND OBJECTIVES: Although the incidence of pediatric celiac disease (CD) is increasing globally, it is uncertain whether this is attributed to improved case ascertainment or signifies a true rise. We aimed to identify all incident cases of childhood CD in southeast Scotland over the period 1990 to 2009 to assess trends in total incidence and cases diagnosed as a result of (1) a classic presentation, (2) a nonclassic presentation, or (3) targeted screening. METHODS: Twenty-year retrospective cohort study of case notes, pathology databases, endoscopy, and patient records for all children (<16 years of age) diagnosed with CD on biopsy in southeast Scotland (at-risk population of 225 000–233 000). Data were age-gender standardized and Poisson regression models used to calculate changes in incidence over time. RESULTS: A total of 266 children were diagnosed from 1990 to 2009 with an increase in incidence from 1.8/100 000 (95% confidence interval [CI] 1.1–2.7) to 11.7/100 000 (95% CI 9.8–13.9) between the epochs 1990 to 1994 and 2005 to 2009, respectively (P < .0001). The incidence of nonclassic presentation (children with a monosymptomatic presentation and those with extraintestinal symptoms) and actively screened cases increased by 1566% (P < .05) and 1170% (P < .001) from 1990 to 1999 to 2000 to 2009, respectively. However, a rise in the incidence of Oslo classic cases from 1.51/100 000 (95% CI 0.91–2.38) in 1990 to 1994 to 5.22/100 000 (95% CI 3.98–6.75) in 2005 to 2009 (P < .01) remained evident. CONCLUSIONS: The incidence of pediatric CD increased 6.4-fold over the 20 years. This study demonstrates that this rise is significant for classic CD, indicating a true rise in the incidence of pediatric CD.

Approximately double the incidence of paediatric CD was observed in the East of Scotland. Evidence of more actively screened cases diagnosed and more antibody tests performed in the region suggests a lower threshold to test. An environmental influence cannot be dismissed since more classic cases were also captured. Further research is needed to highlight the role of any exogenous factors.

Aim To review all incident cases of paediatric coeliac disease (CD) in a UK region over the 20 year period from 1990-2009; to observe trends in incidence, symptom presentation, age at diagnosis and the impact of active screening of at-risk groups; and to audit laboratory results at diagnosis for 01/2005-12/2009. Methods We performed a retrospective audit of case notes, pathology databases, endoscopy and electronic patient records for all children under 16 years diagnosed with CD on duodenal biopsy between 01/1990 and 12/2009 in a UK region of 1.25 million population, of whom 233,000 were aged <16 years of age. Results 266 biopsy positive children were diagnosed during the 20 year study period with a mean increase in age-sex standardised incidence from 1.76 (95% CI 1.08-2.72) to 11.74 (95% CI 9.82-13.93) per 100,000 aged <16 years in the 1990-1994 and 2005-2009 epochs respectively (p=0.001). The median (IQR) age at diagnosis also increased signifi cantly from 29 (16-53.25) months to 90 (53.5-132.5) months in 1990-1994 and 2005-2009 epochs respectively (p<0.0001). 21% of children presented non-classically in 2005-2009 compared to 5% in 1995-1999 (p=0.008); this included children presenting monosymptomatically with one isolated gastrointestinal (GI) symptom and those with extra-intestinal symptoms. 7% of children were diagnosed through targeted screening in 1990-1994 compared to 23% in 2005-2009 (p=0.002). Routine blood investigations demonstrated that over 25% were anaemic and over 50% were iron defi cient at presentation in [2005][2006][2007][2008][2009]. Conclusions The incidence of paediatric CD has increased seven-fold over the last 20 years in a UK region. Children are older at diagnosis, presenting with fewer GI symptoms, and with iron defi ciency anaemia remaining the commonest laboratory abnormality. We suggest that this increase in incidence is largely due to both increased screening of at risk groups and a lower threshold for investigating for CD as a result of greater clinician awareness of the condition's heterogenic nature. A UK-wide study would be benefi cial to identify national trends in incidence and symptomatology.group.bmj.com on July 30, 2012 -Published by adc.bmj.com Downloaded from