Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling

Abstract

Treatment of coeliac disease requires a strict gluten-free (GF) diet, however, a high proportion of patients do not adhere to a GF diet. The study explores the practical challenges of a GF diet and dietary adherence in Caucasian and South Asian adults with coeliac disease. Patients with biopsy- and serology-proven coeliac disease were recruited from a hospital database. Participants completed a postal survey (n = 375), including a validated questionnaire designed to measure GF dietary adherence. Half of Caucasians (53%) and South Asians (53%) were adhering to a GF diet. The quarter of patients (n = 97) not receiving GF foods on prescription had a lower GF dietary adherence score compared with those receiving GF foods on prescription (12.5 versus 16.0; p < 0.001). Not understanding food labelling and non-membership of Coeliac UK were also associated with lower GF dietary adherence scores. A higher proportion of South Asian patients, compared with Caucasians, reported difficulties understanding what they can eat (76% versus 5%; p < 0.001) and understanding of food labels (53% versus 4%; p < 0.001). We recommend retaining GF foods on prescription, membership of a coeliac society, and regular consultations with a dietitian to enable better understanding of food labels. Robust studies are urgently needed to evaluate the impact of reducing the amount of GF foods prescribed on adherence to a GF diet in all population groups.

Coeliac disease in Caucasian and South Asian patients in the North West of England

“…Our results differ from the results of the study by Muhammad et al . who found no significant difference in dietary adherence between Asian and Caucasian patients with coeliac disease. We consider that the differences between the results may result from different methodology of the studies.…”

“…, Holmes and Moor and Muhammad et al . . Given the scarcity of evidence in this area, the existing studies offer invaluable insight into the characteristics of clinical presentation and dietary adherence within this group of patients.…”

“…The study by Muhammad et al . used self‐scoring questionnaires. This methodology has two potential weaknesses.…”

“…A study by Muhammad et al . shows that a significantly larger proportion of Asian patients with coeliac disease report problems understanding what foods they can eat. Similarly, in the same study, a significantly larger proportion of Asian patients reported an inability to understand food labelling.…”

“…Research has corroborated this and suggested that cultural speculation to novel medical treatments and a lack of patient understanding could be significant factors preventing the patients' adherence to a gluten-free diet (9,10) . A study by Muhammad et al (11) shows that a significantly larger proportion of Asian patients with coeliac disease report problems understanding what foods they can eat. Similarly, in the same study, a significantly larger proportion of Asian patients reported an inability to understand food labelling.…”