A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life

Abstract

A dietary interview performed by expert personnel is the best method to check whether patients with coeliac disease follow a strict glutenfree diet (GFD). We previously developed a score based on four fast and simple questions that can be administered even by non-expert personnel. The aim of the present study is to verify the reliability of our questionnaire in a new cohort of patients. The questionnaire has a five-level score. From March 2008 to January 2011, the questionnaire was administered to 141 coeliac patients on a GFD, who were undergoing re-evaluation. The score obtained was compared with persistence of both villous atrophy and endomysial antibodies (EMA). The rate of lower scores was higher among the patients with persistence of either villous atrophy (Fisher's exact, P,0·001; test for trend, P,0·001) or positive EMA (Fisher's exact, P¼ 0·001; test for trend, P¼0·018). Given that the coeliac patients have been well instructed on what a GFD means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a GFD.

Pediatric Celiac Disease Patients Who Are Lost to Follow-Up Have a Poorly Controlled Disease

“…The survey also incorporated a previously validated questionnaire designed by Biagi et al in 2009 [8], which we translated and validated in Hebrew. The questionnaire consists of four simple questions that efficiently evaluate compliance and adherence to GFD.…”

“…The four questions comprise an algorithm (see attached appendix 1), denoting a score according to the patient's answers. The final score of the questionnaire is made up of five levels (0-4), which, from a clinical point of view, can be grouped into three levels: patients who do not follow GFD, patients who follow a GFD but with important errors that require correction, and patients who follow a strict GFD [8]. …”

Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease

“…Among patients diagnosed with CD, we only enrolled those on a GFD for at least 1 year (as documented by the negativity of the anti-transglutaminase and endomysial antibodies) and those with high compliance to GFD, as assessed by administrating a specific questionnaire [27]. Some patients had classical CD with signs and symptoms of malabsorption, including diarrhea, steatorrhea, and weight loss.…”

Nutrition in Celiac Disease

“…Compliance to the diet correlates with intelligence, patients´ age, but also with clinical symptomatology, level of education physician regarding celiac disease and the way to explain this information to the patient [35]. There is very difficult to motivate patients without clinical symptoms, the gluten-free diet in this case cannot improve clinical status.…”

“…The benefit of a gluten-free diet have all patients with celiac disease, regardless of degree of enteropathy [37]. Adherence to a gluten-free diet may be measured using a special questionnaire [35] or by measuring 33-mer gliadin epitope in the stool [33,34]. Clinical symptoms may persist even after the deployment of a gluten-free diet [38], the first measure is necessary to carefully examine adherence to diet.…”