Adherence to a Gluten‐free Diet: Assessment by Dietician Interview and Serology
Abstract
We aimed to determine whether tissue transglutaminase (tTG) autoantibody positivity was associated with dietitian-assessed adherence to a gluten-free diet in pediatric patients with celiac disease and identify areas where adherence falters. We reviewed the records of children with celiac disease who had a standardized evaluation of adherence by a registered dietitian. A negative tTG value was not associated with good adherence (P = NS). Adherent and nonadherent children differed with respect to purposeful and accidental gluten exposure (P < 0.0001), knowledge (P = 0.003), cross-contact (P = 0.003), potential exposure via medications and cosmetics (P = 0.004), and potential exposure while at restaurants (P < 0.0001), but not with respect to potential exposure at school (P = NS). Based on our findings, we suggest that negative tTG levels are not necessarily indicative of good adherence to a gluten-free diet in pediatric patients with celiac disease. A separate assessment of adherence is needed focusing on knowledge, behavior while dining out, and intent to adhere.
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Celiac disease serology markers IgA-TGA and endomysial autoantibodies work very well for diagnosis but are less accurate for dietary monitoring.
“Although CD serology markers (IgA-TGA and endomysial autoantibodies (EmA)) work very well for diagnosis, these are less accurate for dietary monitoring (74, 75).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [74]
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The theory of planned behavior
Ajzen, I. (1991) · Organizational Behavior and Human Decision Processes · doi:10.1016/0749-5978(91)90020-t · Cited by 90,587 · see citing works
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ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease.
Mearin, M. L., Agardh, D., Antunes, H., Al‐toma, A., Auricchio, R., Castillejo, G., Catassi, C., Ciacci, C., Discepolo, V., Dolinsek, J., et al. (2022) · Journal of pediatric gastroenterology and nutrition · doi:10.1097/mpg.0000000000003540 · Cited by 186 · see citing works
- Authors
- Mehta, P., Pan, Z., Riley, M. D., & Liu, E.
- Affiliations
- Children's Hospital Colorado (US)
- Corresponding author
- Mehta, Pooja
- Venue
- Journal of Pediatric Gastroenterology and Nutrition
- Publisher
- Wiley
- Published
- 2018-03
- Volume
- 66
- Issue
- 3
- Pages
- e67-e70
- ISSN
- 0277-2116 (ISSN-L)
- 1536-4801
- OpenAlex
- W2742732093
- Cited by
- 35
- References
- 1
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 1 · 2017: 1
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Gastroenterology and Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007038)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Keywords
- celiac disease, gluten-free diet, dietary adherence, anti-tissue transglutaminase antibodies, pediatric patients, eating out
- MeSH terms
- Protein Glutamine gamma Glutamyltransferase 2, Adolescent, Autoantibodies, Celiac Disease, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Health Knowledge, Attitudes, Practice, Male, Patient Compliance, Transglutaminases, Biomarkers, GTP-Binding Proteins, Diet, Gluten-Free, Young Adult, Nutritionists
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