title: Factors that influence adherence to a gluten-free diet in adults with celiac disease.
abstract: OBJECTIVE
  The only treatment for celiac disease is lifelong adherence to a gluten-free diet, yet adherence is limited and factors influencing adherence are poorly understood. The purpose of this study was to determine factors influencing gluten-free diet adherence in adults with celiac disease.
  
  
  METHODS
  A questionnaire was developed and administered to 154 adults with celiac disease who then underwent a standardized gluten-free diet evaluation by an experienced nutritionist. Multivariate analysis was conducted to determine factors associated with adherence level.
  
  
  RESULTS
  Thirteen factors hypothesized to contribute to gluten-free diet adherence were found to be significantly associated with improved adherence including: understanding of the gluten-free diet, membership of a celiac disease advocacy group, and perceived ability to maintain adherence despite travel or changes in mood or stress (P < 0.001).
  
  
  CONCLUSIONS
  This study identified specific factors correlated with gluten-free diet adherence. These results provide a foundation for the design of educational interventions to improve adherence.
authors.affiliation: Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. dleffler@caregroup.harvard.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
authors.forename: Jessica
authors.initials: J
authors.lastname: Edwards-George
authors.forename: Melinda
authors.initials: M
authors.lastname: Dennis
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.forename: Francis
authors.initials: F
authors.lastname: Cook
authors.forename: Debra L
authors.initials: DL
authors.lastname: Franko
authors.forename: Jessica
authors.initials: J
authors.lastname: Blom-Hoffman
authors.forename: Ciaran P
authors.initials: CP
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000178:diet therapy*; D003627:Data Interpretation, Statistical; D005260:Female; D005983:Glutens; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D005983:Glutens