Predictors of Compliance to Gluten-Free Diet in Children with Celiac Disease.

Anu Garg,Rajkumar Gupta

doi:10.1155/2014/248402

Abstract

Aim. To identify the predictors of compliance to gluten free diet in children with celiac disease. Methods. 134 children in the study group were assessed for dietary compliance followed by a questionnaire based interview. Psychosocial parameters were assessed by standard Pediatric Symptom Checklist (PSC). Dietary compliant and noncompliant groups were compared and assessed for factors affecting the dietary compliance. Predictability of all of these factors was assessed using binary logistic regression analysis with backward elimination to find out the best predictors of compliance. Results. In the study group, 88 (65.67%) were found to be strictly compliant. Factors that were found to be significantly associated with compliance were age at presentation, nuclear families, mother's education, and parents having better knowledge of celiac disease. Parents' and child's attitude towards his having to follow a restrictive diet and child's feelings were also shown to be significantly associated with compliance. Binary logistic regression analysis with backward elimination demonstrated that age at presentation, family type, child's attitude, and child's behaviour made a significant contribution to prediction. Conclusions. These results will contribute to the current body of research by providing health care practitioners with a framework for better dietary instruction to ensure maximum adherence to GFD.

Highlights

Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolamins in genetically susceptible individuals and characterised by the presence of a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies, HLA-DQ2 or HLA-DQ8 haplotypes, and enteropathy [1]
This study evaluates the impact of celiac disease and the gluten-free diet on the lifestyle and well-being of children with celiac disease and their families, with the aim to identify factors affecting compliance to GFD and predictors of compliance to GFD in children with celiac disease
These children visited the clinic for growth monitoring and compliance assessment. 134 consecutive children out of these meeting the following inclusion criteria were enrolled in the study: (1) patients aged between 2 years and 15 years, (2) children diagnosed with celiac disease as per Revised ESPGHAN criteria for diagnosis of celiac disease 1990 [13], (3) those on gluten-free diet for more than 6 months

Summary

Introduction

Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolamins in genetically susceptible individuals and characterised by the presence of a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies, HLA-DQ2 or HLA-DQ8 haplotypes, and enteropathy [1]. In the United States, the overall prevalence of celiac disease in children up to 5 years of age is 1 in 104 [3]. This disease is quite prevalent in India with rates of 1 in 96 in north India [4]. Lifelong adherence to a gluten-free diet (GFD) is the cornerstone treatment of celiac disease [5]. Strict adherence to gluten-free diet may be more challenging in children and adolescents than in adults. Compliance to GFD varies from 45% to 81% in children as reported by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition [8]

Methods

Results

Discussion

Conclusion