The First Assessment of Celiac Disease Knowledge among Kuwaiti Nutritionists through a Validated KAP Model

Ayed Amr^1, , Rima Mashal¹ and Bashayer Al-Enezi¹

¹Department of Nutrition and Food Technology, College of Agriculture, University of Jordan, Amman, Jordan

Cite this paper:
Ayed Amr, Rima Mashal and Bashayer Al-Enezi. The First Assessment of Celiac Disease Knowledge among Kuwaiti Nutritionists through a Validated KAP Model. International Journal of Celiac Disease. 2020; 8(4):136-142. doi: 10.12691/ijcd-8-4-6

Abstract

Registered dietitians /nutritionists play a crucial role in the management of celiac disease (CD). The present study aims to evaluate the knowledge of nutritionists working with CD patients in Kuwait, which has lately been witnessing increased incidence of this disease. A convenient cross-sectional sample of 156 nutritionists from both genders, different age groups, educational levels and experience working in different hospitals and health centers in Kuwait was recruited. To assess their knowledge and practice, a self-administered validated questionnaire was used. Descriptive data analyses were performed using SPSS program. Results of 141 respondents (90% response rate) indicated that nutritionists holding university degrees had highly significant (P ≤ 0.01) higher mean knowledge scores about CD than those holding a diploma degree (9.9 ± 1.3 and 9.3 ± 1.3 vs 8.7± 1.4, out of 14 respectively). It also indicated that ‎gender, geographic area and/or experience had no significant effects (P > 0.05) on the overall mean ‎knowledge scores of the respondents albeit males had higher, though non-significant (P>0.05) mean scores than females in some geographic areas.‎The age of nutritionists had no effect on their knowledge scores despite the longer experience older ones have. The results also indicated that although most nutritionists seem to be well aware of the causes(99.3 %), treatment (98.6%), diagnosis (61%) and complications(78.7%) associated with CD, the majority of them confused it with wheat allergy (78% vs. 22%; P ≤ 0.01). Nutritionists’ knowledge about “Unsafe Ingredients” in the celiac diet information card” was successfully answered by only 6.4% of the participants, whereas 81.6% of them were not sure (p < 0.05). Results of the study emphasize the need for continued-structured education programs for the Kuwaiti nutritionists working with CD patients in all areas related to CD.

Keywords:
celiac disease Kuwait nutritionists knowledge

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Gujral, N., Freeman, H. and Thomson, A. “Celiac disease: prevalence, diagnosis, pathogenesis and treatment.” World journal of gastroenterology: WJG, 18(42). 6036.‏(2012).
[2]	‎‎Rahmoune, H.andBoutrid, N. “Autism & Gluten: The Proof By Regression!.” Pediatric neurology briefs, 32(9). (2018).‏
[3]	Greco, L., Timpone, L., Abkari, A., Abu-Zekry, M., Attard, T., Bouguerra, F….. and Roma,E. “Burden of celiac disease in the Mediterranean area.” World journal of gastroenterology: WJG, 17(45). 4971. (2011).‏
[4]	Barada, K., Daya, H., Rostami, K. and Catassi,, C. “Celiac disease in the developing world.” Gastrointestinal Endoscopy Clinics, 22(4). 773-796. (2012).‏
[5]	Shakeri, R. Malekzadeh,R. sachdev,A. and Fahid, A.. “Coeliac disease in developing countries: Middle East, India and North Africa.” Govaresh, 9(4).242-247.‏ (2012).
[6]	Younes N, Younes S., Alsharabasi O., El Zowalaty M.…… and Zayed, H. “Immunogenetics of celiac disease: a focus on Arab countries.” Current Molecular Medicine, 20(4). 275-285.‏ (2020).
[7]	Abdulrazzaq Y., El-Azzabi T., Al Hamad S., Attia S., Deeb A. and Aburawi,H. “Occurrence of hypothyroidism, diabetes mellitus, and celiac disease in Emirati children with Down’s syndrome.” Oman medical journal, 33(5). 387.‏ (2018).
[8]	Aljebreen, A., Almadi, M., Alhammad, A. and Al Faleh. F. “Seroprevalence of celiac disease among healthy adolescents in Saudi Arabia.” World Journal of Gastroenterology: WJG, 19.15 (2013): 2374.‏
[9]	Abu-Zeid, Y., Jasem, W., Lebwohl, B., Green, P. and El -Ghazali, G.. “Seroprevalence of celiac disease among United Arab Emirates healthy adult nationals: A gender disparity.” World journal of gastroenterology: WJG, 20(42) 15830.‏ ‏(2014).
[10]	Kang, J., Kang, A.,. Green, A., Gwee, K., and Ho, K.. “Systematic review: worldwide variation in the frequency of coeliac disease and changes over time.” Alimentary pharmacology & therapeutics, 38(3). 226-245. ‏(2013).
[11]	Quinteros, S. “Knowledge and behaviors surrounding a gluten-free diet between medically and self-diagnosed individuals.” The FASEB Journal, 30(1_supplement). 1154-28.‏ (2016).
[12]	‎Taus M., Mignini E., Fumelli D., Busni D. and Nicolai, A. “Coeliac Disease: Gluten Free Diet and… What Else?.” Open journal of gastroenterology, 6(11). 319. (2016).‏
[13]	Altamimi, E. “Celiac Disease in South Jordan.” Pediatric gastroenterology, hepatology & nutrition, 20(4). 222-226.‏ (2017).
[14]	Rahmoune, H., Amrane,M. and Boutrid, N. “Celiac Disease: Practical Knowledge of Young Doctors at Setif University Hospital, Algeria”International journal of celiac disease, 8(3). 104-106. 2020.
[15]	Geiger, J., Rhee, Y., Stastny S., Brun,t A. and Salafia,E. “Celiac disease and the gluten-free diet: registered dietitian nutritionists self-reported knowledge varies.” Internationa ljournal of celiac disease, 2(1). 56-61. ‏(2017).
[16]	‎Goodyer, L., Brown, L. and Crowley, E. “Celiac disease knowledge and practice of dietitians in rural New South Wales, Australia.” Food and nutrition sciences. 7(10). 874-883.‏ (2016).
[17]	Green, S. and Salkind, N. Using SPSS for Windows and Macintosh, books a la carte. Pearson, London, UK. 2016.‏
[18]	‎Le, T., Al Kindi, M., Tan, J., Smith, A., Heddle, R., Kette, F., Hissaria, P. and Smith, W. “The clinical spectrum of omega‐5‐gliadin allergy.” Internal medicine journal 46. (6). 710-716.‏ (2016).
[19]	Rahmoune, H., Boutrid, N., Amrane, M., Ouhida, S., Abdellouche, D. and Bioud, B. “Celiac disease & lymphoproliferative malignancy at adulthood.” International journal of celiac disease, 6(2). 47-48. (2018).
[20]	‏Corazza, G. and Villanacci, V. “Coeliac disease.” Journal of clinical pathology, 58(6). 573-574.‏ (2005).
[21]	Rasheed, J., Khan, T., Khalid, M. and Zafar, F. “Celiac disease.” The professional Medical Journal. 25(05). 669-675.‏ (2018).
[22]	Chen, C., Cumbler,E. and Triebling, A. “Coagulopathy due to celiac disease presenting as intramuscular hemorrhage.” Journal of general internal medicine, 22(11). 1608-1612.‏ (2007).
[23]	‎Casella, G., Orfanotti, G., Giacomantonio, L., Di Bella, C., Crisafulli, V., Villanacci, V., ... and Bassotti, G. “Celiac disease and obstetrical-gynecological contribution.” Gastroenterology and hepatology from bed to bench, 9(4)241.‏ (2016).
[24]	Bascunan, K., María C. and Magdalena A. “Celiac disease: understanding the gluten-free diet.” European journal of nutrition, 56(2)449-459.‏(2017) .
[25]	Jackson, J., Eaton, W., Cascella, N., Fasano, A., and Kelly, D. “Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity.” Psychiatric quarterly, 83(1). 91-102. ‏(2012).
[26]	Kaukinen, K., Halme, L., Collin, P., Färkkilä, M., Mäki, M., Vehmanen, P., ... and Höckerstedt, K.. “Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.” Gastroenterology, 122(4). 881-888. ‏‎(2002).
[27]	Green, P. and Christophe, C. “Celiac disease.” New england journal of medicine, 357(17).1731-1743. ‏(2007).
[28]	Food and Drug Administration of USA. “Food labeling: gluten-free labeling of foods. final rule.” Federal register, 78(150). 47154.‏ (2013).
[29]	‎Zanchetta, M., Costa, F., Longobardi, V., Longarini, G., Mazure, R., Moreno, M., .….... . and de la Paz Temprano, M. “Significant bone microarchitecture impairment in premenopausal women with active celiac disease.” Bone, 76.149-157.‏ (2015).
[30]	Ludvigsson, J., Card, T., Ciclitira, P., Swift, G., Nasr, I., Sanders, D. and Ciacci, C.. “Support for patients with celiac disease: A literature review.” United European gastroenterology journal, 3(2).146-159.‏ (2015).
[31]	Pietzak, M., and Kerner, J. “Celiac disease, wheat allergy, and gluten sensitivity: when gluten free is not a fad.” Journal of parenteral and enteral nutrition, 36.68S-75S. ‏(2012).
[32]	Moreno, M. Comino,I., and Sousa, C. “Alternative grains as potential raw material for gluten-free food development in the diet of celiac and gluten-sensitive patients.” Austin journal of nutrition andfood sciences, 2(3)1016.‏ (2014).
[33]	‎Jnawali, P., Vikas, K. and Tanwar, B. “Celiac disease: overview and considerations for development of gluten-free foods.” Food science and human wellness, 5(4). 169-176 (2016).
[34]	‎García‐Manzanares, Á. and Lucendo, A. “Nutritional and dietary aspects of celiac disease.” Nutrition in clinical practice, 26(2). 163-173.‏‏ (2011).
[35]	‎Al-Herz, W., Husain, K., Al-Khabaz, A., Moussa, M. and Al-Refaee, F.”Awareness of food allergies: a survey of pediatricians in Kuwait” BMC pediatrics, 17(11).773-9. (2017).
[36]	Ozcelik, A., Surucuoglu, M. and Akan, L. S.. “Survey on the nutrition knowledge level of Turkish physicians: Ankara as a sample.” Pakistan journal of nutrition, 6(6). 538-542. (2007).‏