Abstract
OBJECTIVES: Strict gluten-free diet (GFD) is the mainstay of therapy in celiac disease (CD), however, data on factors determining long-term adherence is limited. We aimed to compare serology, dietician detailed interview (DDI) and various questionnaires (Biagi, modified Leffler) to assess GFD adherence, to identify determinants of adherence and to assess the impact of counseling. METHODS: In this prospective study, consecutive children (<18 years) with CD on GFD were enrolled between November 2022 and May 2024. GFD adherence was assessed by anti-tissue transglutaminase (tTG), DDI and two questionnaires at baseline and after 6 months of follow-up. RESULTS: A total of 103 children (64 boys, median age 8 years [interquartile range [IQR]: 4-12.5]) on GFD (median duration 35 months [IQR: 11-52]) were enrolled. Adherence as assessed by serology, DDI, Biagi score and modified Leffler score were 73.8%, 48.5%, 66.2%, and 60.3%, respectively. Upon regression analysis, having a sibling with CD, and higher parental knowledge about CD influenced positively to adherence to GFD, while age >10 years and longer duration of follow-up influenced negatively to adherence. After dietary counseling, GFD-adherence improved on follow-up (p < 0.05 in all). CONCLUSIONS: Almost a third of children have adherence issue. Having a sibling with CD, and higher parental awareness about CD positively and older age and longer follow-up negatively influenced GFD-adherence. Adherence improved significantly with dietary counseling on follow-up.