Evaluation of adherence to gluten-free diets in Moroccan celiac patients and factors of adherence failure

Abstract

The prevalence of celiac disease (CD) is increasing in the world. In Morocco, its incidence is also increasing considerably. The gluten-free diet (GFD) remains the only effective treatment so far. Its effectiveness depends essentially on good adherence to this diet. However, several factors hinder adherence by contributing to diet failure. Within this framework, this study aims to evaluate adherence to this diet in celiac children and adolescents continuing in a tertiary health center. The article also looks to identify the different factors influencing adherence to GFD in Morocco. The results show from serological and/or biopsy tests on 238 celiac patients that half had good adherence and 13% had poor adherence. The questionnaire aimed at 127 parents or proxies of celiac children and adolescents shows that several factors are responsible for the failure to adhere to the diet such as the role of the mass media, cultural and psychological factors. The exorbitant price, nutritional quality, and low availability of gluten-free products play a major role in GFD failure. Low socio-economic factors have a negative influence on the adherence to the GFD.

Gluten-Free Diet Compliance in Children With Celiac Disease and Its Effect on Clinical Symptoms: A Retrospective Cohort Study

“…In our population, compliance ranged from 58.7% to 84.6%. Similarly, the Marrakech study estimates that half of the patients were good observers [ 28 ] and the Constantine study shows that 78% of Algerians had good compliance [ 77 ].…”

“…Dietary compliance is highly variable in patients with CD [ 25 ] and is influenced by dietary habits [ 26 ]. In our context, the implementation of the GFD is difficult because the Moroccan diet is based on a significant consumption of wheat and barley [ 4 , 14 , 27 ], and the GFD means a change in the eating habits of the Moroccan people [ 28 ]. However, if the patient shows no clinical response or partial response to gluten withdrawal, a careful evaluation is recommended to rule out accidental ingestion of gluten or poor compliance with the general diet [ 29 ].…”

Celiac Disease in Moroccan Children: Diagnostic Characteristics and Determinants of Diagnosis Delay

“…This should encourage the optimization of diagnostic conditions in children by generalizing autoantibody testing, which is currently the first step of the disease's diagnosis [ 20 ]. In a context like ours [ 22 ], CD is a diagnosis problem [ 17 , 25 ], and its impact is widely underestimated [ 22 ]. In Morocco, epidemiologic studies are lacking; the diagnosis of typical and atypical forms of CD and their frequency are still to be determined [ 12 , 13 ], and the prevalence of CD is unknown [ 26 ].…”

“…A study presented in 2013 on a series of children in Casablanca presented a comparison of clinical aspects over time after the occurrence of serologic tests [ 27 ]. Another study in Marrakech in 2016 presented the experience of the Pediatrics Department of the University Hospital of Marrakech in the care of celiac children [ 25 ]. Finally, in 2021, a study was carried out on the quality of life among children with CD [ 28 ].…”

“…Another study in Marrakech in 2016 presented the experience of the Pediatrics Department of the University Hospital of Marrakech in the care of celiac children [25]. Finally, in 2021, a study was carried out on the quality of life among children with CD [28].…”