Food knowledge and psychological state predict adherence to a gluten‐free diet in a survey of 5310 Australians and New Zealanders with coeliac disease
Open accessAbstract
Summary: Background: A gluten‐free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level. Aim: To comprehensively assess the patient factors that influence gluten‐free diet adherence in patients with coeliac disease. Methods: Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life. Results: Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten‐free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life ( P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten‐free foods, but could still recognise gluten‐containing foods, suggesting that poor knowledge may lead to over‐restriction of diet. Conclusions: Poor knowledge of a gluten‐free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten‐free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.
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A well-informed patient is more likely to adhere to the GFD and to reconstruct normality.
“A wellinformed patient is more likely to adhere to the GFD and to reconstruct normality (149, 150).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [150]
The Discussion reports that better food-knowledge scores independently predicted adherence to a gluten-free diet. The 'Predictors of poorer quality of life' section examines quality of life, but does not establish that better-informed patients are more likely to 'reconstruct normality'; knowledge was not listed among its significant predictors. Our copy provides no page numbers for these passages. (LLM, conf=0.88)
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Yetişkin Çölyak Hastalarının Glutensiz Diyete Uyumu
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- Authors
- Halmos, E. P., Deng, M., Knowles, S. R., Sainsbury, K., Mullan, B., & Tye‐Din, J. A.
- Affiliations
- The Royal Melbourne Hospital (AU)
- UCL Australia (AU)
- Newcastle University (GB)
- Curtin University (AU)
- Department of Gastroenterology The Royal Melbourne Hospital Parkville Vic. Australia
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2018-05-07
- Volume
- 48
- Issue
- 1
- Pages
- 78-86
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2800295921
- Cited by
- 81
- References
- 37
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 15 · 2023: 9 · 2022: 10 · 2021: 13 · 2020: 4 · 2019: 9 · 2018: 5
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Coeliac Australia
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- celiac disease, gluten-free diet, dietary adherence, food knowledge, psychological distress, quality of life, predictors of adherence, dietary restriction, dietitians, mental health services
- MeSH terms
- Adolescent, Adult, Aged, Australia, Celiac Disease, Female, Food, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, New Zealand, Patient Compliance, Prognosis, Quality of Life, Surveys and Questionnaires, Stress, Psychological, Racial Groups, Diet, Gluten-Free, Young Adult
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