Identifying and improving adherence to the gluten-free diet in people with coeliac disease

Abstract

Coeliac disease (CD) is an autoimmune gastrointestinal disorder whereby the ingestion of gluten, a storage protein found in wheat, barley and rye, causes damage to intestinal mucosa with resultant malabsorption, increased risk of anaemia and osteoporosis. Worldwide estimates suggest 1% of the population have CD. With no cure, the only treatment is a gluten-free diet (GFD). Adhering to a GFD can be very challenging; it requires knowledge, motivation and modified behaviours. Assessing adherence to a GFD is methodologically challenging. This review aims to provide an overview of the literature reporting adherence to a GFD in people with CD and the methodological challenges encountered. From six studies it has been reported that rates of adherence to a GFD range between 45 and 90% in patients of different ethnicities with CD. GF dietary adherence can be influenced by age at diagnosis, coexisting depression, symptoms on ingestion of gluten, nutrition counselling, knowledge of GF foods, understanding of food labels, cost and availability of GF foods, receiving GF foods on prescription and membership of a coeliac society. To date only five intervention studies in adults with CD have been undertaken to improve GF dietary adherence. These have included dietary and psychological counselling, and the use of online training programmes, apps, text messages and telephonic clinics. Future interventions should include people of all ethnicities, consider patient convenience and the cost-effectiveness for the healthcare environment.

Intracortical and Intercortical Motor Disinhibition to Transcranial Magnetic Stimulation in Newly Diagnosed Celiac Disease Patients

“…Furthermore, the difference observed did not resist after the Bonferroni correction. However, depressive disturbances can substantially affect the quality of life and are a reliable marker of poor adherence to the diet [ 68 ]. Screening CD subjects for depressive symptoms is therefore crucial, including follow-up visits, to promptly suggest appropriate pharmacotherapy and/or psychological support.…”

Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease

“…Traditional cereal-based gluten-containing foodstuffs such as bread, pasta, and beer must be replaced by corresponding surrogates made from raw materials that do not contain gluten. However, a lifelong strict GFD is not easy, due to gluten ubiquity, cross-contamination of foods, improper labeling, and social constraints [ 20 , 26 ] and, therefore, a considerable portion of patients with CD do not adhere to a GFD. Numerous studies have investigated the factors influencing the compliance to a GFD, showing that adherence rates in patients with CD are well below optimal.…”

“…For example, 38 studies, published up to 2007, indicated an adherence rate ranging between 42 and 91% [ 89 ]. More recently, compliance with a GFD has been reported to be in the range of approximately 45 to 90% [ 20 ]. In the case of children, a systematic review of 49 studies, published up to 2018, revealed adherence rates ranging from 23 to 98% ( Table 1 ) [ 90 ].…”

“…Therefore, non-adherence to a GFD is a daily occurrence, which delays or prevents patient’s healing. Compliance with a GFD among patients with CD, examined in the last few decades, is in the range of 45 to 90% [ 20 ]. Inadvertent gluten intake occurs more frequently than intentional intake, and gluten contamination in naturally or certified gluten-free foods and meals is likely to be one of the most important factors of inadvertent non-adherence to a GFD [ 21 , 22 ].…”

Potencial do inhame no desenvolvimento de produtos para celíacos

“…Nesse contexto, salienta-se a ampliação pela busca por alimentos isentos de glúten, no entanto, a disponibilidade, o dispêndio e a obtenção limitada desses alimentos são fatores capazes intervir no seguimento do tratamento dietético. Desse modo, pontua-se o impacto que certos aspectos refletem na qualidade de vida dos celíacos, dentre eles, pode-se citar: os valores onerosos, a monotonia alimentar e o valor nutricional inferior dos produtos alimentares exclusos de glúten em comparação aos que contém glúten (Hopman, 2008;Muhammad, Reeves & Jeanes, 2019). Research, Society andDevelopment, v. 9, n. 10, e3529108794, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i10.8794 4 Nos últimos anos, nota-se uma crescente pesquisa para a substituição da farinha de trigo por outras matérias-primas alternativas sem glúten, visando desenvolvimento de novos produtos.…”