title: High adherence to a gluten-free diet in adolescents with screening-detected celiac disease.
abstract: OBJECTIVE
  The aim of the study was to evaluate the gluten-free diet (GFD) adherence after 1 year of follow-up in children with screening-detected celiac disease (CD) in a general population.
  
  
  METHODS
  A total of 18,325 twelve-year-olds were invited to participate in a population-based CD screening (Exploring the Iceberg of Celiacs in Sweden), of whom 13,279 participated. In 240 children, CD was detected through elevated anti-tissue transglutaminase antibodies 2 (TG2-IgA) and verified by a small-intestinal biopsy. This substudy included 210 children with TG2-IgA, evaluated both at the initial biopsy occasion and at 1-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n = 193).
  
  
  RESULTS
  After 1 year, 85% (179/210) had normalized TG2-IgA levels (<5 U/mL). Among those who had >50 U/mL at diagnosis, 25% (16/63) still had elevated TG2-IgA, but for the majority their initial values were more than halved. Most reported a high level of GFD adherence ("always" 82% [158/193] and "often" 16% [30/193]), and 75% [145/193] reported always adhering combined with normalized TG2-IgA. Although reporting that they were always adherent, 13 (6.7%) had not yet normalized their TG2-IgA levels completely; however, a majority of these initially had the highest TG2-IgA levels.
  
  
  CONCLUSIONS
  GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12-year-olds. Almost all of them had normalized serology and reported GFD adherence at the 1-year follow-up. A few adolescents who reported GFD adherence, however, had elevated TG2-IgA levels, suggesting more severe disease and/or nonadherence.
authors.affiliation: *Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund †Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå ‡Pediatric Clinic, Norrtälje Hospital, Norrtälje §Department of Clinical and Experimental Medicine, Pediatrics, Faculty of Health Sciences, Linköping University, Pediatrics in Norrköping, Norrköping ¶Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Webb
authors.forename: Anna
authors.initials: A
authors.lastname: Myléus
authors.forename: Fredrik
authors.initials: F
authors.lastname: Norström
authors.forename: Solveig
authors.initials: S
authors.lastname: Hammarroth
authors.forename: Lotta
authors.initials: L
authors.lastname: Högberg
authors.forename: Carina
authors.initials: C
authors.lastname: Lagerqvist
authors.forename: Anna
authors.initials: A
authors.lastname: Rosén
authors.forename: Olof
authors.initials: O
authors.lastname: Sandström
authors.forename: Lars
authors.initials: L
authors.lastname: Stenhammar
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
authors.forename: Annelie
authors.initials: A
authors.lastname: Carlsson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001323:Autoantibodies / Q000032:analysis; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy* / Q000473:pathology; D002648:Child; D002652:Child Behavior; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins / Q000037:antagonists & inhibitors; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D008403:Mass Screening; D010349:Patient Compliance; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D057566:Self Report; D013548:Sweden; D011503:Transglutaminases / Q000037:antagonists & inhibitors
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins