Celiac disease: predictors of compliance with a gluten-free diet in adolescents and young adults.
OBJECTIVE
To identify risk as well as protective factors related to compliance with the gluten-free diet in a cohort of teenagers with celiac disease (CD).


METHODS
Two hundred four patients with CD (European Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria) older than or equal to 13 years and residents of Campania (southern Italy) were enrolled in the study. Patients underwent clinical examination and blood sampling, and were interviewed about school performance, social relationships, family integration, smoking habit, and compliance with a gluten-free diet. Anti-tissue transglutaminase antibodies were assayed with an enzyme-linked immunosorbent assay.


RESULTS
One hundred fifty of 204 (73.5%) reported no dietary transgressions, and 54 of 204 (26.5%) reported occasional or frequent transgressions. During the previous month 29 of 54 (53.7%) poor compliers ate from 0.001 to 1 g of gluten per day, 14 (25.9%) from 1 to 5 g, and 11 (20.4%) more than 5 g. The daily intake of gluten was significantly related to anti-tissue transglutaminase antibodies (chi2 = 38.872, P = 0.000). Height was below the third percentile in 19 of 204 (9.3%), and weight was above the 97th percentile in 20 of 204 (9.8%). Diet compliance did not seem to influence the weight and height. One hundred eleven of 150 good compliers (74%) and 31 of 54 (57.4%) poor compliers were asymptomatic. Most patients reported good family relationships (88.7%), social relationships (91.2%), and school integration (88.2%). Alternatively, 54% of patients reported some limitation in their social life. Compliance was good in patients who reported excellent school integration (83%) and social relationships (81%).


CONCLUSIONS
Optimal school integration significantly contributes to the likelihood of good compliance. A better understanding within the school environment about CD-related issues could improve motivation to adhere to a gluten-free diet.
Errichiello
Simona
S
Department of Pediatrics, University of Magna Graecia, Catanzaro, Italy.
Esposito
Oscar
O
Di Mase
Raffaella
R
Camarca
Maria Erminia
ME
Natale
Clelia
C
Limongelli
Maria Giovanna
MG
Marano
Caterina
C
Coruzzo
Anna
A
Lombardo
Maria
M
Strisciuglio
Pietro
P
Greco
Luigi
L
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001827:Body Height; D001835:Body Weight; D002446:Celiac Disease / Q000097:blood / Q000178:diet therapy* / Q000276:immunology; D055050:Diet, Gluten-Free / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012307:Risk Factors; D012574:Schools; D012931:Social Environment; D011503:Transglutaminases / Q000276:immunology*; D055815:Young Adult
D001323:Autoantibodies; D011503:Transglutaminases