Rate and determinants of non-adherence to a gluten-free diet and nutritional status assessment in children and adolescents with celiac disease in a tertiary Brazilian referral center: a cross-sectional and retrospective study

Abstract

BackgroundCompliance with a gluten-free diet (GFD) is difficult at all ages but particularly for teenagers due to social, cultural, economic, and practical pressures. The multidisciplinary team responsible for the treatment of patients with celiac disease and give support to their parents plays a special role on strengthening GFD and assessing the nutritional and physical health.MethodsA cross-sectional and retrospective study including patients under 20 years of age, with biopsy-confirmed CD, followed regularly at the Department of Pediatrics, Division of Gastroenterology, Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil, were surveyed using a questionnaire and serologic test applied between November 2011 and February 2012. A retrospective chart review of these patients was performed to collect the anthropometric data along with the results of the serologic test performed at the time of diagnosis and after at least 1 year of treatment with a GFD.ResultsWe evaluated 35 patients aged between 2.4 and 19.9 years. Of these 68.6% were female, 88.6% had the typical form of the disease and 51.4% had other comorbidities. The mean age at diagnosis was 5.4 years. Despite dietary guidance, 20% reported non-adherence to the diet. Most children recovered the weight and height deficit after 5 years of treatment, and in some children, excessive weight gain became a concern.ConclusionThe majority of transgressions occurred intentionally at home or at parties. There was a risk of excessive weight gain, especially in the first two years of treatment. More alternatives and easier access to low cost gluten-free foods, increasing the discussion about the benefits of adhering to a GFD among patients, families, and the general population, besides the acquisition of self-management skills, are crucial to fostering independent children and adolescents who have the knowledge and tools to manage life with CD.Electronic supplementary materialThe online version of this article (10.1186/s12876-018-0740-z) contains supplementary material, which is available to authorized users.

The Relationship between Body Composition and a Gluten Free Diet in Children with Celiac Disease

“…Due to this, until recently, these patients were identified exclusively with low BMI. Currently, we know that over time CD may be accompanied by normal as well as excessive body mass, or even by obesity [ 35 , 36 , 37 ], because a GFD may contain both a high energy and high fat load [ 32 ]. The effects of a GFD, related to BMI vary greatly.…”

“…The effects of a GFD, related to BMI vary greatly. Numerous studies show that the strict GFD results in normalization of BMI in initially underweight children and adults [ 28 , 35 , 38 , 39 ], and leads to significantly improved and faster growth and development in children, if the disease is diagnosed and treated early [ 40 ]. Conversely, in individuals with excessive body mass, at the time of CD diagnosis, BMI tends to decrease after the diet is introduced [ 39 ].…”

Descriptive Study of the Different Tools Used to Evaluate the Adherence to a Gluten-Free Diet in Celiac Disease Patients

“…This is mainly due to “cross-contamination”, which arises from eating at a table with other people who eat bread or other wheat products and who often inadvertently drop small fragments of foods that have been contaminated with flour residues during their preparation or handling, etc. It may also be due to the “hidden gluten” that is present in some products that are not adequately labelled [ 11 , 12 ]. People with a basic elementary education and/or with little understanding of how to follow a GFD, or who have little motivation, often believe that they are following the diet strictly, although in practice, they are frequently making mistakes [ 13 ].…”

Nutritional quality of gluten‐free products in Moroccan supermarkets and e‐commerce platforms

“…Nutritional quality was also questionable in several surveys. Following the gluten‐free diet is correlated in several studies with considerable weight gain and obesity development in a large number of adult celiac (Murray, Watson, Clearman, & Mitros, 2004), as well as children and adolescents with celiac disease (Rodrigues, Yonamine, & Fernandes Satiro, 2018). Hence, more importance has been given to discuss the nutritional quality of gluten‐free products.…”