Evaluation of Factors Affecting Compliance to Gluten-free Diet Treatment in Pediatric Celiac Patients

Abstract

Aim: Currently, the only known treatment for celiac disease is lifelong gluten-free diet (GFD) therapy, and the most important problem in the management of the disease is non-compliance with the diet. The aim of this study was to assess the factors affecting compliance to GFD therapy in pediatric celiac patients.

Subjects and Method: 92 randomly selected celiac patients aged 8-18 years, followed in our clinic for at least one year, were evaluated cross-sectionally. The demographic and clinical characteristics of the patients, the social structure of their families and their knowledge of the GFD were examined. Dietary compliance was assessed by patients’ current serum anti-tTG IgA levels. According to the serology results, the patients were divided into 2 groups as adherent and non-adherent to the GFD and the data were compared.

Results: The mean age of the 92 patients was 13.1±3.5 years. The rate of patients with normal anti-tTG IgA levels was 55.4%. The mean age was higher in patients who did not adhere to the GFD (13.8±3.4 years; p<0.05). The mean follow-up period was 5.2±3.9 years. Patients with a follow-up period of less than 2 years (34.8%) had the highest rate (68%) of adherence to diet. The high number of siblings, crowded home environment were the factors that negatively affected diet compliance. No relationship was found between gender, age at diagnosis, symptoms at presentation, presence of comorbidity, level of maternal education and dietary compliance. Knowledge about cross-contamination was not sufficient in 55.4% of the parents.

Conclusion: In this study, dietary non-adherence was found to be quite high in pediatric celiac patients. There was an inverse relationship between time after diagnosis and adherence to diet. It is possible to prevent the morbidity and mortality of the disease by adopting the diet as a lifestyle, persuing it consistently.