title: A prospective comparative study of five measures of gluten-free diet adherence in adults with coeliac disease.
abstract: BACKGROUND
  Increasing numbers of individuals are now being diagnosed with coeliac disease. The only accepted treatment for coeliac disease is lifelong adherence to a strict gluten-free diet (GFD). Individuals' ability to adhere to the GFD varies, but systematic studies guiding the assessment of adherence are currently lacking.
  
  
  OBJECTIVE
  We sought to compare the predictive value of self-report and four serologic tests compared to expert nutritionist evaluation.
  
  
  METHODS
  In all, 154 individual adults with biopsy-proven coeliac disease rated their adherence to the GFD on a Likert scale. Serum antibody titres of IgA anti-tissue transglutaminase, and IgA and IgG anti-deamidated gliadin peptides were determined. Using anova and ROC analyses, results were compared to a standardized evaluation by an expert nutritionist blinded to the participants' self-rated adherence and serology results.
  
  
  RESULTS
  All serologic measures as well as participant reported adherence were significantly associated with GFD adherence as assessed by expert nutritionist evaluation. However, on ROC analysis no measure performed satisfactorily. The performance of serologic testing, but not self-report, improved with increased time on the GFD.
  
  
  CONCLUSIONS
  Although current serologic tests have very high sensitivities and specificities for the diagnosis of coeliac disease, they cannot replace trained nutritionist evaluation in the assessment of GFD adherence.
authors.affiliation: The Celiac Center, Beth Israel Deaconess Medical Center, Department of Gastroenterology, Boston, MA 02215, USA. dleffler@caregroup.harvard.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Leffler
authors.forename: J B
authors.initials: JB
authors.lastname: Edwards George
authors.forename: M
authors.initials: M
authors.lastname: Dennis
authors.forename: E F
authors.initials: EF
authors.lastname: Cook
authors.forename: D
authors.initials: D
authors.lastname: Schuppan
authors.forename: C P
authors.initials: CP
authors.lastname: Kelly
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000178:diet therapy*; D005260:Female; D005983:Glutens; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D016896:Treatment Outcome
chemical_list: D005983:Glutens