Abstract
Adherence to a gluten-free diet (GFD) is currently the mainstay of treatment strategy for celiac disease (CD). The aim of our study was measuring a GFD adherence in CD patients using two newly validated methods of dietary assessment—Standardized Dietician Evaluation (SDE) and the Celiac Dietary Adherence Test (CDAT). Ninety-two adults with CD were evaluated by a registered dietitian with extensive experience with the use of SDE and CDAT. Duodenal biopsy was performed and blood was drawn for serum anti-endomysial, anti-deamidated gliadin peptide and anti-tissue transglutaminase antibodies in forty four of those patients. The results of CDAT and SDE were very convergent, but SDE scores better correlated with serologic and histologic findings. As many as 24–52% of study participants did not adhere well enough to a GFD. Insufficient adherence to a GFD in CD patients is still a significant problem. The knowledge about gluten content in food ingredients and additives is very low among adults with CD. SDE is the most accurate method in assessing compliance with a GFD and is especially helpful in determining hidden sources of gluten. The CDAT may be a fast tool for screening for a GFD adherence in CD patients.
Highlights
Celiac disease (CD) is a lifelong autoimmune disease in which the ingestion of gluten triggers a cellular and humoral immune response leading to small-intestinal mucosal damage in genetically predisposed individuals
New treatment strategies for CD are being developed, until now the only accepted therapy for patients with CD continues to be a lifelong adherence to a gluten-free diet (GFD)
Participation in the study was proposed to all patients who came to the gastroenterologist for a follow-up visit and met the criteria for inclusion
Summary
Celiac disease (CD) is a lifelong autoimmune disease in which the ingestion of gluten triggers a cellular and humoral immune response leading to small-intestinal mucosal damage in genetically predisposed individuals. It is emphasized that such an evaluation should be performed by highly qualified dietitians or physicians with appropriate training, but access to such professionals may be limited Another important problem is that those assessments are non-objective and are not directly comparable, because different methods are used to check a GFD adherence, such as food diaries, 24 h recalls, dietitian interviews, self-reported questionnaires, food frequency questionnaires, or short questions, as it was in the DiGiacomo et al study [21]. The second tool, Celiac Dietary Adherence Test (CDAT) is less time consuming, but according to the authors [11] can identify patients at high risk of poor adherence Both methods were validated in an American population of adults with CD and allowed a reliable assessment of gluten exposure. The aim of the present study was to measure a GFD adherence in Polish CD patients with the use of the CDAT and the SDE and to compare CDAT and SDE scores with results of duodenal biopsies and levels of anti-endomysial (EMA), anti-deamidated gliadin peptide (DGP), and anti-tissue transglutaminase (tTG) antibodies
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