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Cited by 31Celiac Disease Research and ManagementChild Nutrition and Feeding IssuesEosinophilic Esophagitis

Adherence to Gluten-Free Diet in Coeliac Paediatric Patients Assessed through a Questionnaire Positively Influences Growth and Quality of Life

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Pedoto, Deianira, Troncone, Riccardo, Massitti, Margherita, Greco, Luigi, Auricchio, Renata·2020·Nutrients
DOI 10.3390/nu12123802PMC PMC7764452
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Abstract

Assessment of adherence to gluten-free diet (GFD) represents the cornerstone in the management of coeliac disease. The primary aim of this study was to assess diet adherence through a questionnaire adapted to children. The secondary aim was to identify influencing factors and outcomes related to diet adherence. In this study, data about diagnosis, education, quality of life (QoL) and anti-transglutaminase (anti-TG2) titers of 160 coeliac children were collected. For the assessment of diet adherence, all participants completed the questionnaire modified from Leffler et al. (2009), while a random sample of 37 also underwent an extensive dietary interview. According to the questionnaire, diet adherence was excellent in 95 (59.4%), fair in 46 (28.8%) and low in 19 (11.9%) patients. Children diagnosed with biopsy showed better adherence than those with a biopsy-sparing approach (p = 0.036). Adherence to GFD tended to worsen during the follow up, with the average length of follow up being associated with lower scores of diet adherence (p = 0.009). Moreover, adherence to GFD decreased throughout school career, dropping from elementary until high school (p = 0.037). A positive correlation was observed between adherence to GFD and growth percentiles, which increased when higher scores of adherence were achieved. Diet adherence positively correlated with QoL (p = 0.001). In conclusion, the questionnaire displayed good sensitivity in detecting problems in diet adherence, being useful as a screening tool. Better comprehension of influencing factors and outcomes may allow the development of new strategies to improve diet adherence.

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  • There is no clear association between adherence to the gluten-free diet and factors such as gender, the presence of comorbidities other than anxiety and depression, the presence of coeliac disease-related symptoms at diagnosis, the presence of extradigestive symptomatology, family history of coeliac disease, or socioeconomic status.

    “There is no clear association between adherence to the GFD and factors such as gender (132,137,141), the presence of comorbidities other than anxiety and depression (132,141), the presence of CD-related symptoms at diagnosis, the presence of extradigestive symptomatology, family history of CD or socioeconomic status (132).”

    From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [137]

    Results §3.2.2 (page unavailable) reports no statistically significant overall difference in adherence by gender. Results §3.2.1 finds no significant association with parents’ jobs, but does find a significant association with mothers’ education, so the blanket statement about socioeconomic status is not supported. The cited Results passages do not establish the claimed lack of association for comorbidities, symptoms at diagnosis, extradigestive symptoms, or family history. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • More recent studies have reported adherence rates in paediatric patients within the range described.

    “More recent studies have reported adherence rates in paediatric patients within the range described (137,139-141)”

    From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [137]

    Results §3.1 reports adherence rates among 160 paediatric coeliac patients: 59.4% excellent, 28.8% fair, and 11.9% low. This supports the claim that the study reported paediatric adherence rates, but the citing sentence does not give the range it calls “described,” so whether these rates fall within it cannot be checked. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The Biagi questionnaire and CDAT may be useful to detect dietary transgressions in adolescents.

    “however, they may be useful to detect dietary transgressions in adolescents (136,137).”

    From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [137]

    The Methods (§2.2) say the study used a paediatric adaptation of the Leffler questionnaire, including with adolescents. The Discussion (§4) describes it as a useful screening tool for problems with gluten-free diet adherence. Our copy does not identify it as CDAT or assess the Biagi questionnaire, so it does not support the claim about both named instruments. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Several factors that have been identified to influence adherence, either personal or situational factors, are summarized in Figure 6.

    “Several factors that have been identified to influence adherence, either personal or situational factors (environmental barriers that hinder adherence and resources that promote it), are summarized in Figure 6 (47,132,137,141,143,152-164).”

    From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [137]

  • The Biagi questionnaire and CDAT have shown weak sensitivity to detect dietary transgressions in children.

    “However, both have been validated for use in adults only and have shown weak sensibility to detect dietary transgressions in children; however, they may be useful to detect dietary transgressions in adolescents (136,137).”

    From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [137]

    The Introduction (page unavailable) says that short questionnaires were developed for adults, but it does not identify the Biagi questionnaire or CDAT. The Methods and Discussion (pages unavailable) assess a questionnaire adapted from Leffler’s, not the sensitivity of Biagi or CDAT in children. Searches for both named instruments found no passage addressing the claimed weak sensitivity. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Pedoto, D., Troncone, R., Massitti, M., Greco, L., & Auricchio, R.
Affiliations
University of Naples Federico II (IT)
Corresponding author
Pedoto, Deianira
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2020-12-11
Volume
12
Issue
12
Pages
3802
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu12123802
PMC
PMC7764452
OpenAlex
W3111423429
Cited by
31
References
0
Citations by year
2026: 4 · 2025: 9 · 2024: 11 · 2023: 5 · 2022: 1 · 2021: 1
FWCI
1.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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
gluten-free diet adherence, celiac disease, pediatric patients, quality of life, child growth, anti-tissue transglutaminase antibodies, dietary questionnaire, elementary school students, screening tool
MeSH terms
Adolescent, Celiac Disease, Child, Child Development, Child, Preschool, Diet Surveys, Female, Humans, Male, Patient Compliance, Prospective Studies, Quality of Life, Surveys and Questionnaires, Sensitivity and Specificity, Reproducibility of Results, Diet, Gluten-Free, Young Adult

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