Sticking to the Gluten-Free Diet - Most Likely? Least Likely?

In this systematic review involving 7850 children, researchers studied

• the rate of adherence to a gluten-free diet (GFD) in celiac disease children
• risk factors that affect adherence
• outcomes of non-adherence

Myléus A, et al., Clinical Gastroenterology and Hepatology ¹

For this investigation, they incorporated observational studies of ≥50 children diagnosed with celiac disease and recommended for placement on a GFD. In the final analysis, 49 of 703 studies were included.

Substantial variation was found in adherence to a GFD among patients. The adherence rate was not connected with the adherence measurement method, therefore all techniques seem to be helpful, lacking agreement on the optimal metric. Studies are required to identify the best technique for ensuring long-term health compliance and impacts.

The Study ²

Methods

We searched PubMed, Cochrane Library, EBSCO, and Scopus for studies through January 2019. We included observational studies of ≥50 children diagnosed with celiac disease and recommended for placement on a GFD. We collected data on

• adherence assessment (self-report, serology tests, structured dietary interview, biopsies, or assays for gluten immunogenic peptides)
• risk factors
• outcomes related to adherence.

Findings were presented with medians, range, and a narrative synthesis.

Results

We identified 703 studies; of these, 167 were eligible for full-text assessment and 49 were included in the final analysis, comprising 7850 children.

Rates of adherence to a GFD ranged from 23% to 98%. Comparable rates (median rates of adherence, 75%–87%) were found irrespective of how assessments were performed.

• Adolescents were at risk of non-adherence
• Children whose parents had good knowledge about celiac disease adhered more strictly
• Non-adherence associated with patient growth, symptoms, and quality of life.

Conclusion

In a systematic review of 49 studies of children with celiac disease, we found substantial variation in adherence to a GFD among patients. Rate of adherence was not associated with method of adherence measurement, so all methods appear to be useful, with lack of consensus on the ideal metric.

Studies are needed to determine the best method to ensure adherence and effects on long-term health.

¹ https://www.mdlinx.com/journal-summaries/compliance-follow-up-food-intolerance-wheat/2019/07/12/7572008?spec=gastroenterology
²https://www.cghjournal.org/article/S1542-3565(19)30597-X/fulltext?rss=yes