International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2020, 8(3), 90-94
DOI: 10.12691/ijcd-8-3-4
Open AccessArticle

Difficulties Assessing Adherence to Gluten-free Diet in Celiac Patients

María Catalina Vespa1, 2, Amaya Oyarzún Arancibia1, Jimena Ayala Cid2 and Magdalena Araya Quezada1, 2,

1Laboratory of Gastroenterology, Institute of Nutrition and Food Technology, INTA, University of Chile, Macul, Chile

2Corporación de Apoyo al celíaco (COACEL), Macul, Chile

Pub. Date: August 02, 2020

Cite this paper:
María Catalina Vespa, Amaya Oyarzún Arancibia, Jimena Ayala Cid and Magdalena Araya Quezada. Difficulties Assessing Adherence to Gluten-free Diet in Celiac Patients. International Journal of Celiac Disease. 2020; 8(3):90-94. doi: 10.12691/ijcd-8-3-4

Abstract

To date the only efficient treatment of celiac disease is a lifelong gluten-free diet (GFD), which involves relevant lifestyle changes. Numerous methods measure adherence to GFD, but none is completely reliable. The aim of the study was to compare three frequently used methods to measure adherence to GFD and study factors that influence adherence to GFD. Eighty-one celiac patients 15 years or older, on GFD were evaluated by dietitian interview, a Celiac Dietary Adherence Test (CDAT) and blood antitransglutaminase antibodies (tTG). Factors influencing adherence were assessed by an ad-hoc questionnaire following WHO criteria. Adherent and non-adherent patients were classified in the same category in 44.4% of cases (n=36), (non-adherent=35.8% and adherent= 8.6%). In general, methods identified better non-adherent than adherent individuals. Among the 5 realms defined by WHO, when tTG (positive/negative) defined adherence, logistic regression identified ten significant variables (information about disease, income, education, cost of gluten-free products, eating in restaurants, time on GFD, symptoms at diagnosis, number of symptoms at time of diagnosis, other chronic diseases present, allergy/food intolerance plus a chronic disease and CD). Using the interview as reference, two variables were significant (self-perception of knowledge of the GFD, and presence of gastrointestinal symptoms when gluten is consumed). Results illustrate the difficulties of measuring both adherence to GFD and the factors that influences it. Further studies should explore new markers able to measure the amount of gluten necessary to activate autoantibodies production and the time they take to stop their production once the patient stops gluten ingestion.

Keywords:
celiac disease adherence CDAT serum antitransglutaminase antibodies interview

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References:

[1]  Fasano A, Catassi C. Clinical practice. Celiac disease. N Engl J Med. 2012 Dec 20; 367(25): 2419-26.
 
[2]  Lionetti E, Catassi C. New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. Int Rev Immunol. 2011 Aug; 30(4): 219-31.
 
[3]  Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology. 2005 Apr; 128(4 Suppl 1): S121-7.
 
[4]  Simpson S, Thompson T. Nutrition assessment in celiac disease. Gastrointest Endosc Clin N Am. 2012 Oct; 22(4): 797-809.
 
[5]  Bascunan KA, Vespa MC, Araya M. Celiac disease: understanding the gluten-free diet. Eur J Nutr. 2016 2016; 56(2): 449-59.
 
[6]  Nasr I, Leffler DA, Ciclitira PJ. Management of celiac disease. Gastrointest Endosc Clin N Am. 2012 Oct; 22(4):695-704.
 
[7]  Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology. 2001 Feb; 120(3):636-51.
 
[8]  Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther. 2009 Aug 15; 30(4): 315-30.
 
[9]  Mondragón A AM, Roessler JL, Ríos G, Bergenfreid C, Alarcón T. [Does a gluten free diet affects the celiaca patient's family diet?]. Revista Chilena de Pediatría. 1999(26): 53-61.
 
[10]  WHO. Adherence to long - term therapies: Evidence for action. World Health Organization. 2003.
 
[11]  Lanzini A, Lanzarotto F, Villanacci V, Mora A, Bertolazzi S, Turini D, et al. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment Pharmacol Ther. 2009 Jun 15; 29(12): 1299-308.
 
[12]  Sharkey LM, Corbett G, Currie E, Lee J, Sweeney N, Woodward JM. Optimising delivery of care in coeliac disease - comparison of the benefits of repeat biopsy and serological follow-up. Aliment Pharmacol Ther. 2013 Nov; 38(10): 1278-91.
 
[13]  Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion. 2002; 66(3): 178-85.
 
[14]  Newnham ED, Shepherd SJ, Strauss BJ, Hosking P, Gibson PR. Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5-year longitudinal study from diagnosis. J Gastroenterol Hepatol. 2015 Feb; 31(2): 342-9.
 
[15]  Leffler DA, Dennis M, Edwards George JB, Jamma S, Magge S, Cook EF, et al. A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin Gastroenterol Hepatol. 2009 May; 7(5): 530-6, 6 e1-2.
 
[16]  Biagi F, Bianchi PI, Marchese A, Trotta L, Vattiato C, Balduzzi D, et al. A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life. Br J Nutr. 2012 Nov 28; 108(10): 1884-8.
 
[17]  Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013 May; 108(5): 656-76; quiz 77.
 
[18]  See JA, Kaukinen K, Makharia GK, Gibson PR, Murray JA. Practical insights into gluten-free diets. Nature reviews Gastroenterology & hepatology. 2015 Oct; 12(10): 580-91.
 
[19]  Viljamaa M, Collin P, Huhtala H, Sievanen H, Maki M, Kaukinen K. Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther. 2005 Aug 15; 22(4): 317-24.
 
[20]  Whitaker JK, West J, Holmes GK, Logan RF. Patient perceptions of the burden of coeliac disease and its treatment in the UK. Aliment Pharmacol Ther. 2009 May 15; 29(10):1131-6.
 
[21]  Leffler DA, Edwards-George J, Dennis M, Schuppan D, Cook F, Franko DL, et al. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig Dis Sci. 2008 Jun; 53(6): 1573-81.
 
[22]  Butterworth JR, Banfield LM, Iqbal TH, Cooper BT. Factors relating to compliance with a gluten-free diet in patients with coeliac disease: comparison of white Caucasian and South Asian patients. Clin Nutr. 2004 Oct; 23(5): 1127-34.
 
[23]  Villafuerte-Galvez J, Vanga RR, Dennis M, Hansen J, Leffler DA, Kelly CP, et al. Factors governing long-term adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary pharmacology & therapeutics. 2015 Sep; 42(6): 753-60.
 
[24]  Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology. 1992 Jan; 102(1): 330-54.
 
[25]  Fueyo-Diaz R, Gascon-Santos S, Asensio-Martinez A, Sanchez-Calavera MA, Magallon-Botaya R. Transcultural adaptation and validation of the Celiac Dietary Adherence Test. A simple questionnaire to measure adherence to a gluten-free diet. Rev Esp Enferm Dig. 2016 mar; 108(3): 138-44.
 
[26]  Vahedi K, Mascart F, Mary JY, Laberenne JE, Bouhnik Y, Morin MC, et al. Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. The American journal of gastroenterology. 2003 May; 98(5): 1079-87.
 
[27]  Sugai E, Nachman F, Vaquez H, Gonzalez A, Andrenacci P, Czech A, et al. Dynamics of celiac disease-specific serology after initiation of a gluten-free diet and use in the assessment of compliance with treatment. Dig Liver Dis. 2009 May; 42(5): 352-8.
 
[28]  Mehta P, Pan Z, Riley MD, Liu E. Adherence to a Gluten-free Diet: Assessment by Dietician Interview and Serology. J Pediatr Gastroenterol Nutr. 2017 Mar; 66(3): e67-e70.
 
[29]  Wessels MMS, Te Lintelo M, Vriezinga SL, Putter H, Hopman EG, Mearin ML. Assessment of dietary compliance in celiac children using a standardized dietary interview. Clin Nutr. 2017 2017; 37(3): 1000-4.
 
[30]  Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR. Tests for Serum Transglutaminase and Endomysial Antibodies Do Not Detect Most Patients With Celiac Disease and Persistent Villous Atrophy on Gluten-free Diets: a Meta-analysis. Gastroenterology. 2017 Sep; 153(3): 689-701 e1.
 
[31]  Moreno ML, Rodriguez-Herrera A, Sousa C, Comino I. Biomarkers to Monitor Gluten-Free Diet Compliance in Celiac Patients. Nutrients. 2017 Jan 6; 9(1).
 
[32]  Verma AK, Gatti S, Galeazzi T, Monachesi C, Padella L, Baldo GD, et al. Gluten Contamination in Naturally or Labeled Gluten-Free Products Marketed in Italy. Nutrients. 2017 Feb 7; 9(2).
 
[33]  Lee HJ, Anderson Z, Ryu D. Gluten contamination in foods labeled as "gluten free" in the United States. J Food Prot. 2014 Oct; 77(10): 1830-3.
 
[34]  Farage P, de Medeiros Nobrega YK, Pratesi R, Gandolfi L, Assuncao P, Zandonadi RP. Gluten contamination in gluten-free bakery products: a risk for coeliac disease patients. Public Health Nutr. 2016 Feb; 20(3): 413-6.
 
[35]  Sainsbury K, Mullan B, Sharpe L. A randomized controlled trial of an online intervention to improve gluten-free diet adherence in celiac disease. Am J Gastroenterol. 2013 May; 108(5): 811-7.
 
[36]  Kurppa K, Lauronen O, Collin P, Ukkola A, Laurila K, Huhtala H, et al. Factors associated with dietary adherence in celiac disease: a nationwide study. Digestion. 2012; 86(4): 309-14.
 
[37]  Bacigalupe G, Plocha A. Celiac is a social disease: family challenges and strategies. Fam Syst Health. 2015 Mar; 33(1): 46-54.
 
[38]  Bao F, Yu L, Babu S, Wang T, Hoffenberg EJ, Rewers M, et al. One third of HLA DQ2 homozygous patients with type 1 diabetes express celiac disease-associated transglutaminase autoantibodies. J Autoimmun. 1999 Aug; 13(1): 143-8.
 
[39]  Sardy M, Csikos M, Geisen C, Preisz K, Kornsee Z, Tomsits E, et al. Tissue transglutaminase ELISA positivity in autoimmune disease independent of gluten-sensitive disease. Clinica chimica acta; international journal of clinical chemistry. 2007 Feb; 376(1-2): 126-35.