ArticleEuropean journal of clinical nutrition2024
Barriers at various levels of human ecosystem for maintaining adherence to gluten free diet in adult patients with celiac disease.
Article in European journal of clinical nutrition, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 11 citations in OpenAlex.
- Dietary Therapies for Gastrointestinal Disorders.Nutrients · 2026Review
- Factors associated with adherence to gluten-free diet among celiac patients in Palestine: a cross-sectional study.Scientific reports · 2026Article
- Developing a Measure to Assess General Knowledge for Coeliac Disease.Health expectations : an international journal of public participation in health care and health policy · 2026Article
- Article
- Efficacy of Large Language Models in Providing Evidence-Based Patient Education for Celiac Disease: A Comparative Analysis.Nutrients · 2025Article
- Celiac Disease and Gluten Cross-Contact: How Much is too Much?Current nutrition reports · 2025Review
- Gluten-Free Diet and Health-Related Quality of Life: The Validated Hellenic Version of the Celiac Dietary Adherence Test.Nutrients · 2025Article
- Dietary management of irritable bowel syndrome: considerations, challenges, and solutions.The lancet. Gastroenterology & hepatology · 2024Review
- Review
- A Systematic Review of Tools to Assess Coeliac Disease-Related Knowledge.Journal of clinical medicine · 2024Review
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Authors and funding
11 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionWhile lifelong and strict adherence to gluten-free diet (GFD) is essential for the successful treatment of celiac disease (CeD), only 30-50% of patients are able to maintain a good adherence to GFD. We determined factors influencing the adherence to GFD at various ecological levels including intra-personal, inter-personal, organizational, community and system-based levels in adult patients with CeD.
methodsA questionnaire to assess the adherence was developed and it was administered in the CeD clinic to patients with CeD on GFD for >1 year. Adherence to GFD was assessed in a subset of patients (n = 320) using Celiac Disease Adherence Test (CDAT).
resultsOverall, 978 patients [median age: 29 years; females: 592] with CeD on GFD were recruited. They reported many barriers to adherence to GFD including intra-personal barriers such as lack of knowledge about GFD (19%), inadequate financial resources (27.2%) and lack of self-motivation/confidence (55.3%); inter-personal barriers such as intake of gluten-containing food upon forceful insistence of friends/family (23.4%); organizational barriers such as high cost (70.8%) and non-availability of GF-food products (48.6%); community-based barriers like consumption of gluten-containing food at religious occasions/festivals (11.1%) and social occasions (27.2%); and system-based barriers such as non-referral to dietitian for counseling (21.9%). As per CDAT, 204 (63.7%), 73(22.8%) and 43(13.4%) patients had good, average, and poor adherence to GFD, respectively. On multivariable analysis, occasional consumption of gluten, non-availability of GF-food while dining out and coercing by family and friends for consumption of GC-food were found to have highest odds for poor adherence to GFD.
conclusionsNon-referral to a dietitian for counseling, irregular follow-up visits, unavailability of flour mill, non-supportive family/friends, high cost and limited availability of GF-food are the most common barriers to adherence to GFD. There is a need to create infrastructure and develop strategies to overcome these diverse barriers at various levels of ecosystem and thereby facilitate better adherence to GFD.
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