Determinants and Trends of Adherence to a Gluten-Free Diet in Adult Celiac Patients on a Long-term Follow-up (2000–2020)

Schiepatti, Annalisa; Maimaris, Stiliano; Nicolardi, Maria Luisa; Alimenti, Eleonora; Vernero, Marta; Costetti, Martina; Costa, Stefania; Biagi, Federico

doi:10.1016/j.cgh.2020.12.015

Cited by 16 publications

(27 citation statements)

References 29 publications

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“…Although risk of developing pre-malignant/malignant complications is virtually absent in patients diagnosed during childhood/adolescence [5,8,9], delivering a high standard quality of care after transitioning to adulthood and maintenance of long-term adherence to a gluten-free diet (GFD) are crucial for prevention of disease-related morbidity, worsening of quality of life (QOL), and risk of malignant complications [1][2][3][10][11][12][13]. In this regard, in adults, it has been shown that dietary adherence remains largely stable over follow-up, and when it changes, it usually improves [14]. Pattern of clinical presentation at diagnosis of CD as well as cognitive, emotional, and socioeconomic factors has also been shown to influence long-term adherence to a GFD [14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…In this regard, in adults, it has been shown that dietary adherence remains largely stable over follow-up, and when it changes, it usually improves [14]. Pattern of clinical presentation at diagnosis of CD as well as cognitive, emotional, and socioeconomic factors has also been shown to influence long-term adherence to a GFD [14][15][16][17][18][19][20]. On the contrary, no data are available on long-term dietary patterns and predictors thereof in celiac patients diagnosed in the pediatric setting and then referred to adult care.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Adherence to a Gluten-Free Diet and Quality of Life of Celiac Patients After Transition to an Adult Referral Center

et al. 2021

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Background Modalities for the transition to adult care of celiac patients diagnosed during childhood/adolescence and their impact on long-term adherence to a gluten-free diet (GFD-A), quality of life (QOL) and maintenance of follow-up in adulthood are unknown. Aims To evaluate whether timing of transition affects long-term GFD-A, QOL, and continuity of follow-up in adulthood and to identify predictors of long-term GFD-A. Methods Clinical and demographic data about pediatric care and adult follow-up at our center were retrospectively collected from clinical notes of celiac patients diagnosed during childhood/adolescence and then referred to our tertiary center. QOL and adult long-term GFD-A were prospectively evaluated with validated questionnaires. These parameters were studied by means of univariate and multivariate statistical analysis. Results 183 patients (130F, mean age at diagnosis 7.6 ± 5.8 years) were enrolled. Median age at transition to adult care was 20 years (IQR 17-25). There was no relationship between age at transition to adult care, long-term GFD-A, QOL, and continuity of follow-up. GFD-A tended to improve overall from pediatric care to adult referral (OR 2.92, 95% CI 1.13-7.87, p = 0.02) and also throughout adult follow-up (OR 9.0, 95% CI 4.2-19.7, p < 0.01). On multivariable logistic regression analysis, classical symptoms at diagnosis of celiac disease (p = 0.02) and good GFD-A at adult referral (p < 0.01) predicted good long-term GFD-A, while being lost to follow-up predicted poorer long-term GFD-A (p = 0.02). Conclusions Clinical characteristics can guide development of personalized strategies for implementing long-term GFD-A and ensure maintenance of regular follow-up in celiac patients diagnosed in childhood/adolescence and transitioning to adult care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term Adherence to a Gluten-Free Diet and Quality of Life of Celiac Patients After Transition to an Adult Referral Center

et al. 2021

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“…Facilitators in complying with the strict GFD include the understanding of the diet itself, membership of a CD advocacy group, the perception of the ability to maintain compliance despite stress, mood changes, and travel [ 131 ], cognitive, emotional, and socio-cultural influences, and regular follow-up with a dietician [ 132 ]. Another important determinant of adherence to a GFD in celiac patients is the presentation of classical symptoms at diagnosis, such as diarrhea and weight loss [ 133 ]. However, the factors of young age at diagnosis, adolescence, long duration of disease, non-academic education, below-average income, and no gastroenterology follow-up have been shown to be barriers to GFD adherence [ 134 , 135 ].…”

Section: The Gluten-free Diet and Diet Adherencementioning

confidence: 99%

“…However, the factors of young age at diagnosis, adolescence, long duration of disease, non-academic education, below-average income, and no gastroenterology follow-up have been shown to be barriers to GFD adherence [ 134 , 135 ]. In addition, anemia and dermatitis herpetiformis have indicated poor long-term compliance [ 133 ]. Furthermore, there are positive predictors of long-term GFD compliance, including classical CD symptoms at diagnosis and upon initial adherence to the diet.…”

Section: The Gluten-free Diet and Diet Adherencementioning

confidence: 99%

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Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders

Alkalay

2021

Nutrients

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Lactose malabsorption (LM), celiac disease (CD), non-celiac gluten sensitivity (NCGS), and irritable bowel syndrome (IBS) are conditions associated with food triggers, improvement after withdrawal, treatment with dietary restriction, and subsequent nutritional detriments. LM occurs when there is incomplete hydrolysis of lactose due to lactase deficiency and frequently produces abdominal symptoms; therefore, it can cause lactose intolerance (LI). A lactose-restricted diet is frequently recommended, although it can potentially lead to nutrient deficiencies. Furthermore, lactose is an essential component of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) and is subsequently associated with intolerance to these compounds, especially in IBS. LM commonly presents in CD. Nutritional deficits are common in CD and can continue even on a gluten-free diet (GFD). Conditions triggered by gluten are known as gluten-related disorders (GRDs), including CD, wheat allergy, and NCGS. IBS can also be associated with a gluten sensitivity. A GFD is the treatment for CD, GRDs, and gluten sensitive IBS, although compliance with this restricted diet can be difficult. Strict dietary therapies can have a negative effect on quality of life. This review aims to provide an overview of the difficult nutritional elements of these disorders, which are critical for medical providers to recognize when managing these patients.

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Follow-Up of Paediatric Patients with Celiac Disease

Fernandes

Lopes

2021

Advances in Celiac Disease

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Determinants and Trends of Adherence to a Gluten-Free Diet in Adult Celiac Patients on a Long-term Follow-up (2000–2020)

Cited by 16 publications

References 29 publications

Long-Term Adherence to a Gluten-Free Diet and Quality of Life of Celiac Patients After Transition to an Adult Referral Center

Long-Term Adherence to a Gluten-Free Diet and Quality of Life of Celiac Patients After Transition to an Adult Referral Center

Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders

Follow-Up of Paediatric Patients with Celiac Disease

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