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

Abstract

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.

A systematic review of adherence to restricted diets in people with functional bowel disorders

“…While these findings should be confirmed in further research, the relationship between gender and adherences indicates a potential need for additional support for men following a diagnosis of FBD. The findings for lifestyle impact and challenges accessing food are consistent with research in other areas which have found perceived barriers and selfefficacy to be important predictors of adherence (Clark-Cutaia, Ren, Hoffman, Burke, & Sevick, 2014;Hall, Rubin, & Charnock, 2013;Platt et al, 2014). Interventions that seek to reduce perceived barriers to adherence and improve self-efficacy may be successful in improving adherence in this population.…”

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

“…This specific hypothesis, as well as the broader question of directionality, requires testing. Intentional gluten consumption appears to be less common (Hall et al, 2009;Hall, Rubin, & Charnock, 2013). More high-quality research, using prospective and longitudinal designs, is needed to provide a more definitive answer to the question of causality.…”

“…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). Commonly used adherence measures, such as single-item self-report questions (e.g., 'how strictly do you adhere to your GFD?'…”

The potential utility of tight junction regulation in celiac disease: focus on larazotide acetate

“…However, adherence to a GFD is difficult [Rashtak and Murray, 2012]. A recent study from the UK indicates that more than 70% of diagnosed CD patients consume gluten either intentionally or inadvertently [Hall et al 2013]. Furthermore, a GFD is not enough to suppress the disease or completely alleviate symptoms in a substantial number of patients .…”