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Clinical nutrition, enteral and parenteral nutrition

Determinants of adherence to gluten-free diet in Greek children with coeliac disease: a cross-sectional study

Abstract

Background/Objective:

A strict and lifelong commitment to a gluten-free diet (GFD) remains one of the most challenging issues in children with coeliac disease. The present study aimed to record compliance rates and investigate the connection between dietary compliance and demographics, disease-related factors and parental knowledge.

Subjects/Methods:

Parents of 90 Greek children diagnosed with coeliac disease were recruited from the outpatient gastroenterology clinic of a children’s hospital in Athens, Greece. Dietary compliance and a range of demographic and clinical data were obtained from parents through a specially constructed questionnaire. Further data included parental perceived and actual knowledge about coeliac disease and GFD. Compliant and noncompliant groups were compared for measured factors and a multivariate approach was followed to elicit independent effects of compliance determinants.

Results:

Overall, 44.4% of children with coeliac disease were reported to be compliant to a strict GFD. A 1-year increase in the age of the child was associated with 15% lower odds of adhering to a strict diet after adjusting for other variables (odds ratio (OR)=0.85, 95% CI: 0.75–0.96). Parental perceived knowledge was also independently and significantly associated with dietary compliance (OR=3.3, 95% CI=1.1–9.8). No statistically significant correlation emerged between dietary compliance and other clinical or demographic variables.

Discussion:

Low compliance rates to GFD were observed in children with coeliac disease. Information based on children’s age and perceived parental knowledge can be used to develop risk profiles that health care professionals can utilise to identify children likely to be noncompliant and thus adjust their counselling strategy accordingly.

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References

  1. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40: 1–19.

    Article  Google Scholar 

  2. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136–160.

    Article  CAS  Google Scholar 

  3. Rewers M . Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology 2005; 128 (4 Suppl 1), S47–S51.

    Article  Google Scholar 

  4. Telega G, Bennet TR, Werlin S . Emerging new clinical patterns in the presentation of celiac disease. Arch Pediatr Adolesc Med 2008; 162: 164–168.

    Article  Google Scholar 

  5. Hoffenberg EJ, MacKenzie T, Barriga KJ, Eisenbarth GS, Bao F, Haas JE et al. A prospective study of the incidence of childhood celiac disease. J Pediatr 2003; 143: 308–314.

    Article  Google Scholar 

  6. Logan RF, Rifkind EA, Turner ID, Ferguson A . Mortality in celiac disease. Gastroenterology 1989; 97: 265–271.

    Article  CAS  Google Scholar 

  7. Metzger MH, Heier M, Maki M, Bravi E, Schneider A, Lowel H et al. Mortality excess in individuals with elevated IgA anti-transglutaminase antibodies: the KORA/MONICA Augsburg cohort study 1989–1998. Eur J Epidemiol 2006; 21: 359–365.

    Article  CAS  Google Scholar 

  8. Holmes GK, Prior P, Lane MR, Pope D, Allan RN . Malignancy in coeliac disease—effect of a gluten free diet. Gut 1989; 30: 333–338.

    Article  CAS  Google Scholar 

  9. Ljungman G, Myrdal U . Compliance in teenagers with coeliac disease—a Swedish follow-up study. Acta Paediatr 1993; 82: 235–238.

    Article  CAS  Google Scholar 

  10. Mayer M, Greco L, Troncone R, Auricchio S, Marsh MN . Compliance of adolescents with coeliac disease with a gluten free diet. Gut 1991; 32: 881–885.

    Article  CAS  Google Scholar 

  11. Roma E, Roubani A, Kolia E, Panayiotou J, Zellos A, Syriopoulou VP . Dietary compliance and life style of children with coeliac disease. J Hum Nutr Diet 2010; 23: 176–182.

    Article  CAS  Google Scholar 

  12. Chauhan JC, Kumar P, Dutta AK, Basu S, Kumar A . Assessment of dietary compliance to gluten free diet and psychosocial problems in Indian children with celiac disease. Indian J Pediatr 2010; 77: 649–654.

    Article  CAS  Google Scholar 

  13. Fabiani E, Catassi C, Villari A, Gismondi P, Pierdomenico R, Ratsch IM et al. Dietary compliance in screening-detected coeliac disease adolescents. Acta Paediatr Suppl 1996; 412: 65–67.

    Article  CAS  Google Scholar 

  14. Fabiani E, Taccari LM, Rδtsch I-M, Di Giuseppe S, Valentino Coppa G, Catassi C . Compliance with gluten-free diet in adolescents with screening-detected celiac disease: a 5-year follow-up study. J Pediatr 2000; 136: 841–843.

    Article  CAS  Google Scholar 

  15. Anson O, Weizman Z, Zeevi N . Celiac disease: parental knowledge and attitudes of dietary compliance. Pediatrics 1990; 85: 98–103.

    CAS  PubMed  Google Scholar 

  16. Jackson PT, Glasgow JF, Thom R . Parent’s understanding of coeliac disease and diet. Arch Dis Child 1985; 60: 672–674.

    Article  CAS  Google Scholar 

  17. Roma E, Panayiotou J, Karantana H, Constantinidou C, Siakavellas SI, Krini M et al. Changing pattern in the clinical presentation of pediatric celiac disease: a 30-year study. Digestion 2009; 80: 185–191.

    Article  Google Scholar 

  18. Steele R . Diagnosis and management of coeliac disease in children. Postgrad Med J 2011; 87: 19–25.

    Article  Google Scholar 

  19. Pietzak MM . Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology 2005; 128 (4 Suppl 1), S135–S141.

    Article  Google Scholar 

  20. Mearin ML . Celiac disease among children and adolescents. Curr Probl Pediatr Adolesc Health Care 2007; 37: 86–105.

    Article  Google Scholar 

  21. Cinquetti M, Micelli S, Zoppi G . Adolescents and celiac disease: psychological aspects. Pediatr Med Chir 1997; 19: 397–399.

    CAS  PubMed  Google Scholar 

  22. Kokkonen J, Viitanen A, Simila S . Coping with a coeliac diet after adolescence. Helv Paediatr Acta 1989; 43: 261–265.

    CAS  PubMed  Google Scholar 

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Correspondence to D Charalampopoulos.

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Charalampopoulos, D., Panayiotou, J., Chouliaras, G. et al. Determinants of adherence to gluten-free diet in Greek children with coeliac disease: a cross-sectional study. Eur J Clin Nutr 67, 615–619 (2013). https://doi.org/10.1038/ejcn.2013.54

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