E P Halmos1,2, M Deng3, S R Knowles1,4,5,6, K Sainsbury7, B Mullan8, J A Tye-Din1,9,10. 1. Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia. 2. Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Vic., Australia. 3. Cartovera Pty. Ltd., Adelaide, SA, Australia. 4. Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Vic., Australia. 5. Department of Mental Health, St Vincent's Hospital, Fitzroy, Vic., Australia. 6. Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia. 7. Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK. 8. Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Bentley, WA, Australia. 9. Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia. 10. Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia.
Abstract
BACKGROUND: A gluten-free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level. AIM: To comprehensively assess the patient factors that influence gluten-free diet adherence in patients with coeliac disease. METHODS: Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life. RESULTS: Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten-free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life (P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten-free foods, but could still recognise gluten-containing foods, suggesting that poor knowledge may lead to over-restriction of diet. CONCLUSIONS: Poor knowledge of a gluten-free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten-free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.
BACKGROUND: A gluten-free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level. AIM: To comprehensively assess the patient factors that influence gluten-free diet adherence in patients with coeliac disease. METHODS:Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life. RESULTS: Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten-free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life (P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten-free foods, but could still recognise gluten-containing foods, suggesting that poor knowledge may lead to over-restriction of diet. CONCLUSIONS: Poor knowledge of a gluten-free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten-free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.
Authors: Alejandro Martínez-Rodríguez; Daniela Alejandra Loaiza-Martínez; Javier Sánchez-Sánchez; Jacobo Á Rubio-Arias; Fernando Alacid; Soledad Prats-Moya; María Martínez-Olcina; Rodrigo Yáñez-Sepúlveda; Nuria Asencio-Mas; Pablo J Marcos-Pardo Journal: Front Nutr Date: 2022-06-16