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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



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.


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.


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.


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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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).

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  • gluten enteropathy
  • noncompliance
  • gluten-free diet
  • parental knowledge

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