title: Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: School of Applied Sciences, University of Sunderland, Sunderland, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Hall
authors.forename: G
authors.initials: G
authors.lastname: Rubin
authors.forename: A
authors.initials: A
authors.lastname: Charnock
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000178:diet therapy* / Q000523:psychology; D005515:Food Labeling; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D010349:Patient Compliance; D055815:Young Adult
chemical_list: D005983:Glutens