A prospective comparative study of five measures of gluten‐free diet adherence in adults with coeliac disease

Leffler, Daniel A.; George, Jessica B. Edwards; Dennis, Melinda; Cook, E. Francis; Schuppan, Detlef; Kelly, Ciarán P.

doi:10.1111/j.1365-2036.2007.03501.x

Cited by 134 publications

(117 citation statements)

References 22 publications

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“…The study recruited a large community sample of people with CD, avoiding the biases associated with recruitment in secondary care or from members of patient societies. shown to correlate to other more objective measures in other studies (Biagi et al 2012, Leffler et al, 20072009). Our data demonstrates that the majority of respondents were able and willing to self-report their adherence in this way and the anonymous nature of the questionnaire may have for facilitated the admission of intentional lapses for some respondents.…”

Section: Discussionmentioning

confidence: 65%

“…However, perceived difficulty is associated with the frequency of mistakes made and the confidence in one's ability to stick to the diet (self-efficacy). A lack of a direct association between the reported difficulty of the GFD and adherence has been found by others (Casellas et al, 2006;Leffler et al, 2007). One UK study found, however, that difficulties such as understanding food labelling, affordability, obtaining GF foods and obtaining enough GF foods on prescription were all significantly associated with compliance, but that this was also dependent upon ethnicity (Butterworth, Banfield, Iqbal & Cooper, 2004).…”

Section: Discussionmentioning

confidence: 91%

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Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

2013

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Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in Appetite. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be re ected in this document. Changes may have been made to this work since it was submitted for publication. A de nitive version was subsequently published in Appetite, 68, 2013Appetite, 68, , 10.1016Appetite, 68, /j.appet.2013 Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. ABSTRACTAdherence to a gluten-free diet is the mainstay of treatment for coeliac disease. Nonadherence is common as the diet is restrictive and can be difficult to follow. This study aimed to determine the rates of intentional and inadvertent non-adherence in adult coeliac disease and to examine the factors associated with both. A self-completion questionnaire was mailed to adult coeliac patients identified from the computer records of 31 family practices within the North East of England. We received 287 responses after one reminder. Intentional gluten consumption was reported by 115 (40%) of respondents. 155 (54%) had made at least one known mistaken lapse over the same period and 82 (29%) reported neither intentional nor mistaken gluten consumption.Using logistic regression analysis, low self-efficacy, perceptions of tolerance to gluten and intention were found to be independently predictive of intentional gluten consumption. A statistical model predicted 71.8% of cases reporting intentional lapses.Intentional non-adherence to the GFD was found to be common but not as frequent as inadvertent lapses. Distinguishing the factors influencing both intentional and inadvertent non-adherence is useful in understanding dietary self-management in coeliac disease.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 91%

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

2013

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“…Debate exists on the optimal way to measure GFD adherence (Leffler et al, 2007;Ludvigsson et al, 2014;Vahedi et al, 2003), resulting in large variation in definitions and measurement across studies (Hall, Rubin, & Charnock, 2009). Intentional gluten consumption in patients with CD appears rare, with unintentional non-adherence (e.g., due to cross contamination or errors in label reading) representing the most common reason for lapsing from the GFD (Hall, Rubin, & Charnock, 2013;Sainsbury et al, 2013a).…”

Section: Introductionmentioning

confidence: 99%

“…Commonly used adherence measures, such as single-item self-report questions (e.g., 'how strictly do you adhere to your GFD?' with Likert or visual analogue response scales from 'not at all' to 'very strictly') and serological analyses, are unreliable at detecting incomplete adherence, particularly with increased time on a GFD (Leffler et al, 2007). These methods also do not correlate well with dietitian-rated assessments (Fera, Cascio, Angelini, Martini, & Guidetti, 2003;Leffler et al, 2007;Vahedi et al, 2003), the method currently deemed the 'gold standard' (Leffler et al, 2007;Ludvigsson et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…with Likert or visual analogue response scales from 'not at all' to 'very strictly') and serological analyses, are unreliable at detecting incomplete adherence, particularly with increased time on a GFD (Leffler et al, 2007). These methods also do not correlate well with dietitian-rated assessments (Fera, Cascio, Angelini, Martini, & Guidetti, 2003;Leffler et al, 2007;Vahedi et al, 2003), the method currently deemed the 'gold standard' (Leffler et al, 2007;Ludvigsson et al, 2014). The dietitian assessment involves completion of a 3-day food record (prior to the session), a food ingredient quiz, and a dynamic clinical interview in which an experienced dietitian evaluates the food record with the patient to identify any gluten consumption or sources of cross-contamination that may compromise adherence.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

Sainsbury

Marques

2018

Appetite

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Conflicts of interest: none Funding: none 2The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis ABSTRACT Purpose: Depressive symptoms are common in patients with coeliac disease (CD) and may represent a barrier to gluten free diet (GFD) adherence. The aims of this meta-analysis were: (1) to synthesise the evidence on the relationship between depression or depressive symptoms and degree of adherence to a GFD in patients with CD who are already attempting a GFD (i.e., post-diagnosis and onset of GFD), and (2) to summarise the direction of causation of any observed relationship. Methods:A random effects meta-analysis of 8 cross-sectional studies (N=1644) was conducted.Included studies measured self-reported depressive symptoms and GFD adherence using either a dietitian interview or validated self-report questionnaire that considered unintentional gluten consumption.Results: There was a moderate association between poorer GFD adherence and greater depressive symptoms (r=0.398, 95% CI=0.321-0.469), with marked heterogeneity in the effects (I 2 =66.8%). A sensitivity analysis excluding studies with a moderate/high (k=1) or unclear risk of bias (k=1) did not change the results. Conclusion:The low number of studies meeting inclusion criteria limits the strength of the conclusions. Available evidence suggests there is an association between poorer GFD adherence and self-reported depressive symptoms; however, studies using longitudinal and prospective designs, and reliable measures, particularly for adherence, are needed to confirm this association. The direction of causation between depression and adherence remains unclear.

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Celiac Disease Diagnosis and Management

Leffler¹

2011

JAMA

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Celiac disease is one of the most prevalent autoimmune gastrointestinal disorders but as the case of Ms. J illustrates, diagnosis is often delayed or missed. Based on serology studies, the prevalence of celiac disease in many populations is estimated to be approximately 1% and has been increasing steadily over the last 50 years. Evaluation for celiac disease is generally straightforward, and uses commonly available serologic tests, however the signs and symptoms of celiac disease are nonspecific and highly heterogeneous making diagnosis difficult. While celiac disease is often considered a mild disorder treatable with simple dietary changes, in reality celiac disease imparts considerable risks including reduced bone mineral density, impaired quality of life, and increased overall mortality. In addition, the gluten free diet is highly burdensome and can profoundly affect patients and their families. For these reasons, care of individuals with celiac disease requires prompt diagnosis and ongoing multidisciplinary management.

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A prospective comparative study of five measures of gluten‐free diet adherence in adults with coeliac disease

Cited by 134 publications

References 22 publications

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

Celiac Disease Diagnosis and Management

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