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Systematic review: Adherence to a gluten-free diet in adult patients with coeliac disease

Lookup NU author(s): Dr Nicola HallORCiD, Emeritus Professor Greg RubinORCiD


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Background Coeliac disease is increasingly diagnosed in adult patients who present with atypical symptoms or who are asymptomatic and detected by case screening. Its treatment, a gluten-free diet, can have a considerable impact on daily living. Understanding the factors associated with non-adherence is important in terms of supporting patients with their condition. Aim To investigate factors associated with adherence to a gluten-free diet in adults with coeliac disease. Methods A literature search of multiple electronic databases using a pre-determined search string for literature between 1980 and November 2007 identified a possible 611 hits. After checking for relevance, 38 studies were included in this review. Results Rates for strict adherence range from 42% to 91% depending on definition and method of assessment and are the lowest among ethnic minorities and those diagnosed in childhood. Adherence is most strongly associated with cognitive, emotional and socio-cultural influences, membership of an advocacy group and regular dietetic follow-up. Screen and symptom-detected coeliac patients do not differ in their adherence to a gluten-free diet. Conclusions The existing evidence for factors associated with non-adherence to a gluten-free diet is of variable quality. Further and more rigorous research is needed to characterize those individuals most likely to be non-adherent to assist them better with their treatment. © 2009 Blackwell Publishing Ltd.

Publication metadata

Author(s): Hall NJ, Rubin G, Charnock A

Publication type: Review

Publication status: Published

Journal: Alimentary Pharmacology and Therapeutics

Year: 2009

Volume: 30

Issue: 4

Pages: 315-330

Print publication date: 01/08/2009

Online publication date: 20/07/2009

ISSN (print): 0269-2813

ISSN (electronic): 1365-2036


DOI: 10.1111/j.1365-2036.2009.04053.x

PubMed id: 19485977