Celiac Disease and Gluten-Free Diets: A Path or Barrier to Food (In)Security?

Abstract

Background: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion. The only effective treatment is adherence to a gluten-free diet (GFD), which is challenging due to the widespread presence of gluten in foods and the lack of physical and financial access to gluten-free options, among other factors that can lead to food nutrition insecurity (FNI). FNI, defined as the difficulty in accessing adequate food, is a factor that not only affects the need to adhere to a GFD but also compromises adherence itself. Objective: Review the scientific literature on the association between FNI, celiac disease, and adherence to a gluten-free diet. Methodology: This integrative review was conducted systematically using the PubMed, Scopus, and Web of Science databases, selecting studies that evaluated food security and insecurity among celiac patients. The keywords used with the Boolean operators were "celiac disease" AND/OR "gluten-free diet" AND "food insecurity" AND/OR "food security". The search did not restrict language or geographic location, and studies were selected independently by two reviewers. Results: Ten publications met the inclusion criteria and were selected for the integrative review. FNI has been studied over the last five years in CD patients, but there is a lack of studies in different regions. FNI negatively affects the quality of life for those with CD and contributes to more severe symptoms and lower adherence to the GFD, especially in children and low-income families. Factors associated with higher risks of FNI in those with celiac disease include income, education, living in rural or non-central areas, and availability. These factors reinforce the negative impact of the association between FNI and adherence to the GFD in CD patients. Conclusions: The study of FNI in celiac individuals is a relatively recent development. The prevalence of FNI in this population is concerning and higher than in the general population, and it is associated with adherence to the GFD. Therefore, this topic demands extensive public policies to improve the health, quality of life, adherence, and treatment of CD patients.

Keywords: celiac disease; food insecurity; food security; gluten-free diet.

Figure 1

Flowchart of study selection process.

Figure 2

Factors influencing (and being influenced by) FNI and gluten-free diet adherence in celiac patients. Blue lines represent positive influences, and orange lines represent negative influences.