Factors that influence adherence to a gluten-free diet in adults with celiac disease

Abstract

Objective: The only treatment for celiac disease is lifelong adherence to a gluten-free diet, yet adherence is limited and factors influencing adherence are poorly understood. The purpose of this study was to determine factors influencing gluten-free diet adherence in adults with celiac disease.

Methods: A questionnaire was developed and administered to 154 adults with celiac disease who then underwent a standardized gluten-free diet evaluation by an experienced nutritionist. Multivariate analysis was conducted to determine factors associated with adherence level.

Results: Thirteen factors hypothesized to contribute to gluten-free diet adherence were found to be significantly associated with improved adherence including: understanding of the gluten-free diet, membership of a celiac disease advocacy group, and perceived ability to maintain adherence despite travel or changes in mood or stress (P < 0.001).

Conclusions: This study identified specific factors correlated with gluten-free diet adherence. These results provide a foundation for the design of educational interventions to improve adherence.

Fig. 1

Distribution of reported and assessed gluten-free diet adherence expert evaluation scoring: 1—excellent, participant eats gluten fewer than three times per year (<3 per year); 2—good, participant eats gluten one time per month; 3—fair, participant eats gluten 2–3 times per month; 4—poor, participant eats gluten 1–2 times per week; 5—very poor, participant eats gluten more than two times per week (>2 per week); 6—participant does not follow the gluten-free diet. Self-reporting scoring: 1—highly compliant with the gluten-free diet; 2—moderately compliant with the gluten free diet, 3—moderately noncompliant with the gluten-free diet, 4—highly noncompliant with the gluten-free diet, 5—I am not following a gluten-free diet at this time, 6—participant does not follow a gluten-free diet