Abstract
Globally, celiac disease (CD) affects around 1-2% of the population. Gluten elimination becomes the cornerstone treatment and is also being followed by non-celiac as a healthy dietary habit. However, there is lack of sustainable evidence to understand this view. Adherence to gluten-free diet (GFD) rendered a few to reduced quality of life. Hence, a meta-analysis has been performed to determine interaction of GFD and Health-related Quality of Life (HRQoL). NCBI/MEDLINE, PubMed, Cochrane Library, Google Scholar and Science Direct were combed from date of inception to October 30, 2018 for studies assessing the effect of GFD using validated questionnaires on HRQoL a) between healthy controls and celiac patients b) dietary adherence to GFD in celiac subjects. Random effect model was used for meta-analysis. Twenty-five studies comprising 5148 CD subjects fit in the inclusion criteria. GFD had moderate significant association with HRQoL, for PGWB odds ratio’s (OR) 0.613 [95% CI, 0.449-0.837], SF-36 Mental Component Score (MCS) 0.026 [95% CI, 0.011-0.060], Physical Component Score (PCS) 0.066 95% [CI, 0.032-0.138]. Partial adherence to GFD had lower quality of life when compared to strictly adherent patients for OR’s SF-36 MCS 5.080 [95% CI, 1.885- 13.692], PCS 3.204 [95% CI, 1.579- 6.503] and CDQoL 2.439 [95%CI (1.724- 3.450)]. The results implied moderate significant association between GFD and HRQoL and better compliance leads to favourable HRQoL.
Highlights
Celiac Disease (CD) is an autoimmune inflammatory enteropathy affecting globally around 1-2% of individuals in which women are more susceptible as compared to men,[1] distinguished by continual gluten intake intolerance in genetically predisposed populace
From the forest plot (Fig 2), it is evident that gluten free diet has moderately affected the Health-related Quality of Life (HRQoL) with ORs[95%CI] 0.613 [0.4490.837] with p=0.002 and moderate heterogeneity (I2) was reported i.e. 73.08%
Effect of Dietary Adherence on Celiac Disease Patients Based on eleven studies, in total 1852 patients, we found that HRQoL is significantly affected based on dietary adherence
Summary
Celiac Disease (CD) is an autoimmune inflammatory enteropathy affecting globally around 1-2% of individuals in which women are more susceptible as compared to men,[1] distinguished by continual gluten intake intolerance in genetically predisposed populace. The gene alleles HLA DQ2 and/or HLA DQ8 and the ingested gluten interaction in CD patients provoke an abnormal mucosal immune response causing villous atrophy. A complex interplay among specific genes, environmental factors and gluten is necessary for CD to develop as not everyone who is genetically predisposed will develop the disease.[2] Of late, the world has awakened to the severity and complexities arising due to CD. Researchers have suggested that α-gliadin (component of gluten and rich in glutamine) is the main causative agent that leads to the immune response.[2,3] Owning to its chronic nature, there are histological alterations in the small bowel leading to nutrient malabsorption, psychological stress, social and family tribulation, capital strain and restrictions on different life decisions.[4,5] The dire consequences of these can be observed on the Health-related Quality of Life (HRQoL) as well. The only treatment is life-long withdrawal of gluten and a fundamental and perpetual transformation in dietetic habits
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