Factors relating to compliance with a gluten-free diet in patients with coeliac disease: comparison of white Caucasian and South Asian patients

Abstract

Background & aims: To identify factors relating to compliance with a gluten-free diet amongst white Caucasian and South Asians with coeliac disease. Methods: Cross-sectional survey, with case note review of 130 adult patients with coeliac disease (90 white Caucasian and 40 South Asians). Results: 87 (66.9%) of the 130 questionnaires were returned; whites: 73.3%, South Asians: 52.5% ( P=0.02). White Caucasians’ assessment of their own strictness to the gluten-free diet correlated with small bowel histological recovery (OR 10.00, 95% CI 3.2–33.06) and negative endomysial antibodies (OR 34.94, CI 6.58–185.40). This was not seen in the South Asian patients. Amongst the white coeliacs, factors correlating with compliance with a gluten-free diet were: Coeliac Society membership, understanding food labelling, obtaining sufficient gluten-free products, explanation by a physician, and regular dietetic follow-up. These factors were not identified amongst the South Asians, who were less likely to attend dietetic clinics, join the Coeliac Society and be satisfied with information provided by doctors and dieticians. Conclusions: In contrast to the South Asians, factors were identified which related to compliance with a gluten-free diet amongst white Caucasian coeliac patients. This study has shown that the treatment approach to ethnic minorities with coeliac disease must be improved.