A Randomized Controlled Trial of an Online Intervention to Improve Gluten-Free Diet Adherence in Celiac Disease

Abstract

The online program was effective in improving adherence and represents a promising resource for individuals with celiac disease who are struggling to achieve or maintain adequate gluten free diet adherence.

The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

“…Based on these tentative findings, there may be a role for psychological services in addition to dietetic input in the ongoing management and follow-up of GFD adherence for affected CD patients (Ludvigsson et al, 2014;NICE, 2015), even in cases of low-level, subclinical depressive symptoms (NICE, 2009). Online and face-to-face interventions using both individual and group-based formats have shown promise in improving GFD adherence and psychological wellbeing in CD (Addolorato et al, 2004;Ring Jacobsson, Friedrichsen, Goransson, & Hallert, 2012;Sainsbury, Mullan, & Sharpe, 2013c), and could help to achieve needed improvements in both directions. Higher depression scores were associated with poorer adherence (r = 0.48, p < .001).…”

“…Note: CD = coeliac disease; GFD = gluten free diet; CDAT = coeliac dietary adherence test; BDI = Beck Depression Inventory; DASS = Depression, Anxiety, Stress Scale; PGWB = Psychological General Wellbeing Index (2013) NR NR NR SL VL Unclear VL = very likely; SL = somewhat likely; NL = not likely; NR = not reported * Not likely rating based on significant attrition from baseline to both 1-year and 4-year follow-up, a lack of details reported on differences between dropouts and those who remained in the study, and failure to account for attrition in follow-up analyses (i.e., per-protocol analysis rather than intention-totreat) ~ Power analysis reported in linked paper on same sample (randomised controlled trial of behavioural intervention to improve GFD adherence; Sainsbury, Mullan, & Sharpe, 2013c) # Statistics for the relationship between depressive symptoms and GFD adherence were not reported -raw data obtained from study authors and analyses conducted by first author…”

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

“…Participants were the baseline sample recruited to an online intervention to improve GFD adherence, coping, and QOL in CD (60). The recruitment strategy (email sent to 1500 members; April 2012), inclusion criteria, most measures, and procedure in this study were identical to study one.…”

The challenges of control groups, placebos and blinding in clinical trials of dietary interventions

“…However, other evidence suggests the expectation of future intervention in 140 wait-list controls could also lead to unwanted improvement in endpoints, essentially leading 141 to an underestimation of effect in the treatment group. For example, wait-list controls in 142 energy restriction studies have lost weight (10) , in coeliac adherence studies they have reported 143 improvements in quality of life (11) and in irritable bowel syndrome they have reported 144 symptom improvements (13) . Despite this, "no treatment" controlled trials, including those 145 utilising wait-list controls, are appropriate for trials with objective outcomes that might be less likely to respond to biases (e.g.…”

“…patients waiting for a routine appointment) who present a convenient 134 "no treatment" control population (9)(10)(11) . (12) .…”