Impact of Corona Virus Disease 2019 pandemic on adherence to gluten-free diet in Indian patients with celiac disease

Abstract

Aims Lockdown and restricted mobility due to the pandemic of corona virus disease 2019 (COVID-19) has severely affected the continuity of healthcare of patients with acute and chronic diseases. We evaluated the impact of COVID-19 on the adherence to gluten-free diet (GFD), symptom control, and quality of life (QOL) in patients with celiac disease (CeD). Methods A questionnaire, consisting of both ad-hoc and validated questions, was created after review of literature, group discussions, and expert meetings. Standardized questionnaires namely CeD adherence test (CDAT), celiac symptom index score, and CeD-related QOL were used. The web-based questionnaire was sent to 3130 patients via social media and 452 responses (14.4%) were received. Also, additional 68 patients (not available on any social media application) were interviewed telephonically by a trained dietitian. Results Overall, 505 patients (females: 318; mean age: 24.1±14.2 years) were included. While only 6.7% ( n = 34) had poor compliance to GFD (CDAT > 17) before COVID-19 pandemic, it almost doubled to 12.6% ( n = 64) during the COVID-19 pandemic times ( p = 0.02). Furthermore, 4.9% ( n = 25) of patients were diagnosed contacting COVID-19. Interestingly, 73.2% ( n = 370) patients preferred online appointment than physical appointment. Most common difficulties faced during lockdown period were high delivery charges for getting gluten-free (GF) food at home (54.4%), increased prices of regular GF food (43.1%), and travelling long distance to arrange GF food (44.9%). Conclusions The COVID-19 pandemic has substantially affected the adherence, symptom control, and QOL in patients with CeD, attributable to unavailability, shortage of money, and heightened cost of GF food. The pandemic has offered an opportunity to practice teleconsultation approach for patients with CeD. Supplementary Information The online version contains supplementary material available at 10.1007/s12664-021-01213-4.

Perceived barriers to gluten-free diet adherence by people with celiac disease in Greece

“…Restrictions in commuting in conjunction with online orders resulted in difficulties getting food supplies and a limitation in food variety, especially for those living in the provinces. Contrary to our results, food availability was hampered in some parts of the world [ 7 , 31 ].…”

“…Furthermore, all the aspects of life that had previously been described as factors affecting GFD adherence were potentially influenced by the unprecedented phenomenon of the COVID-19 pandemic. For example, studies have reported that the pandemic both impeded GF food availability and affected its cost [ 6 , 7 ].…”

Celiac Disease and Targeting the Molecular Mechanisms of Autoimmunity in COVID Pandemic

“…In conclusion, as a positive effect, the pandemic paved the way for teleconsultation for patients with CD but negatively affected the GFD, symptom management, and the QOL due to lack of money at home, high costs for the purchase and delivery of GF food at home, sometimes very difficult to find. Future steps should be taken to maintain GF food supply chains, online consultation and monitoring of CD patients in case of regional lockdowns or across the country [ 102 ].…”

COVID-19 and celiac disease: a review

“…An overwhelming majority preferred to have an online appointment rather than a physical one. 38 Barriers to telemedicine include language barriers, difficulty using technology, and lack of telephone or internet access. 36 …”