title: Factors associated with dietary adherence in celiac disease: a nationwide study.
abstract: OBJECTIVE
  Diagnostics and follow-up of celiac disease have gradually shifted from tertiary centers to secondary and primary health care. In order to establish whether this has affected the success of treatment, and to identify predictors for dietary non-adherence, we carried out a study in a nationwide cohort of treated celiac patients.
  
  
  METHODS
  843 biopsy-proven patients, 94 children and 749 adults, were enrolled and interviewed. Adherence to a gluten-free diet was determined by means of an interview and serological testing.
  
  
  RESULTS
  Altogether, 88% were on a strict gluten-free diet; the rest had occasional dietary transgressions. Younger age at diagnosis, being currently a teenager, and current symptoms were associated with non-adherence. There was no association between non-adherence and place of diagnosis, gender, disease phenotype or severity of symptoms before diagnosis, presence of comorbidities, family history of celiac disease, smoking, duration of diet, use of oats, self-efficacy for the diet or lack of follow-up.
  
  
  CONCLUSIONS
  Good dietary adherence can be achieved also in patients diagnosed and followed in primary health care. In a country with a high prevalence and good general knowledge of celiac disease, only age at diagnosis and age at present would appear to be major determinants for adherence.
authors.affiliation: Pediatric Research Center, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
authors.forename: Olli
authors.initials: O
authors.lastname: Lauronen
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Anniina
authors.initials: A
authors.lastname: Ukkola
authors.forename: Kaija
authors.initials: K
authors.lastname: Laurila
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D055050:Diet, Gluten-Free; D005260:Female; D005387:Finland; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D012698:Serologic Tests; D055815:Young Adult