Eating Competence and Aspects Related to a Gluten-Free Diet in Brazilian Adults with Gluten-Related Disorders

Abstract

This cross-sectional study aims to assess eating competence (EC—an intra-individual approach to food, behaviors, and attitudes related to food) and aspects related to a gluten-free diet (GFD) in Brazilian adults with gluten-related disorders (GRDs). The research was conducted using an online survey with a self-reported instrument consisting of 40 items, organized into three parts: (I) Socioeconomic and demographic data; (II) the Brazilian version of the Eating Competence Satter Inventory (ec-SI2.0™BR); and (III) questions about adherence and difficulties in following the gluten-free diet. EC was measured by the ecSI2.0™BR instrument, with scores ≥32 were considered competent eaters. The instrument was applied nationwide through the GoogleForms® platform from 14 February 2022 to 30 March 2022. The publicity for the recruitment was supported by Brazilian celiac local and national associations (Acelbras and Fenacelbra), pages of food services or personal pages of tips and posts about gluten-related disorders, and specialized stores that offer gluten-free foods. The recruitment occurred through social networks (emails, Facebook groups, WhatsApp, and Instagram). A total of 1030 Brazilians with GRDs answered the questionnaire. Most participants were female, aged 40 years or older, with an income >R$3000, and a high education level. The main difficulty regarding adherence to GFD was the high cost of gluten-free foods. Individuals younger than 40 years old had lower EC scores, with no differences between men and women. Increasing socioeconomic status, schooling, and culinary practices increased the total score. Participants who “never/almost never” felt socially judged because their diet had higher scores for total EC. Competent eaters GRD individuals (EC ≥ 32) were mostly individuals aged ≥ 40 y/o; with income > R$3000; following a GFD; satisfied with purchased gluten-free products; consuming gluten-free products prepared at home, mainly by themselves; who do not feel judged because of the GRD and who feel that they can live a normal life with GRD. Our study showed that individuals who strictly adhere to the GFD have higher scores on eating competence than those who sometimes follow the treatment.

Division of Responsibility in Child Feeding and Eating Competence: A Cross-Sectional Study in a Sample of Caregivers of Brazilian Children with Celiac Disease

“…A GFD requires knowledge about food, management of the food environment, meal planning, and attention to labels, so a GFD likely needs one to meet the EC requirements. In a Brazilian study on individuals with gluten-related disorders (n = 1030), higher eating competence scores were found in adults with CD compared to the general population, with an association between compliance with a GFD and a higher total ecSI2.0 TM BR score [22].…”

“…The caregivers' GFD compliance was self-reported, since there is no validated instrument to evaluate GFD compliance in Brazil. Therefore, self-reported GFD compliance was used following other studies [19,22,[29][30][31][32][33]. The participants chose the option that best characterized their current diet regarding the following question: "Do you comply with a gluten-free diet?".…”

“…A recent study in Brazil evaluated the division of responsibility in infant feeding and EC among Brazilian caregivers in general (n = 549) [21]. Other Brazilian studies have been developed applying the ecSI2.0 TM BR in a sample of 1030 adults diagnosed with gluten-related disorders, most of them being celiac [22], and the general population (n = 1810) [23]. However, no study has assessed the association between eating competence, the division of responsibility in feeding, and children with CD's adherence to the gluten-free diet in Brazil.…”

Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnaires

“…In this sense, our results may not represent the general Portuguese celiac people. In addition, despite the broad use of self-reported compliance to a GDF ( 34 , 39 , 48 – 52 ), we could not confirm the information ( 62 ), since data collection occurred online due to the COVID-19 pandemic restrictions, limiting the access to confirmation by laboratory tests. Despite the Portuguese Celiac Association has distributed the questionnaire to participants from all regions of Portugal to encompass the range of experiences and viewpoints of people living with CD in the country, the questionnaire did not ask for their exact location limiting the discussion about cultural and sociodemographic aspects.…”

“…Considering data collection occurred during the COVID-19 pandemic, it was not possible to validate a new instrument to evaluate it since the laboratory tests were limited. Therefore, we opt to use self-reported GFD compliance, as performed in other studies ( 34 , 39 , 48 – 52 ). Participants chose the option that best characterized their current diet regarding the question: “Do you follow a gluten-free diet?”.…”