Abstract
BACKGROUND: Coeliac disease requires strict lifelong adherence to a gluten-free diet, although adherence is challenged by the limited availability and higher cost of gluten-free foods. The demand for gluten-free foods has increased over recent years, yet its impact on availability and cost is unknown. This study aims to assess the availability and cost of gluten-free food across diverse retail outlets and compare changes over 11 years. METHODS: Replicating the same methodology as our previous study in 2010, the availability and cost of 20 foods (10 wheat-based, 10 everyday foods) were assessed in 30 stores across a diverse range of London boroughs and compared over an 11-year period. For each of the 20 foods, the cost of four products were selected (branded gluten-free, cheapest gluten-free, branded standard, cheapest standard) and compared. RESULTS: Availability of the 20 foods in 2021 was generally limited, with an average of 7.6 (SD 5.7) gluten-free foods per store (38.2% of foods surveyed). Regular supermarkets in particular saw a reduction in availability over time from 18.0 (SD 2.0) of the 20 foods (90% of foods) available in gluten-free versions in 2010 decreasing to 14.0 (SD 1.4, 70%) in 2021 (p = 0.008). Gluten-free foods were more expensive than gluten-containing counterparts. In terms of secular trends, the 2021 cost generally exceeded inflation-adjusted estimates; however, the ratio between the cost of gluten-free and gluten-containing foods declined over the 11 years. CONCLUSIONS: Over 11 years in the UK, gluten-free food availability remained limited and more costly. Any impact of sustained limited availability and higher cost on adherence to a gluten-free diet should be addressed and interventions to overcome these issues should be tested.