title: Cost and availability of gluten-free food in the UK: in store and online.
abstract: OBJECTIVE
  Coeliac disease (CD) is a lifelong condition requiring strict adherence to a gluten-free (GF) diet and good availability of GF foods is critical to this. Patients with CD from lower socioeconomic groups are recognised to have higher treatment burden and higher food costs may impact this. Therefore, we aimed to assess the availability and cost of GF food in supermarkets and via the internet.
  
  
  METHODS
  Supermarkets and internet shops delivering to homes in a single city (UK) were analysed between February and March 2014. Stores were identified with comprehensive internet searches. Ten commonly purchased items were analysed for cost and compared with standard non-GF alternatives. Direct measurement of the number of GF foods available was compared between stores which were categorised according to previously published work.
  
  
  METHODS
  Supermarkets covering the whole of Sheffield, UK.
  
  
  RESULTS
  None of the budget supermarkets surveyed stocked any GF foods. Quality and regular supermarkets stocked the greatest range, each stocking a median of 22 (IQR 39) items (p<0.0001). All GF foods were at least four times more expensive than non-GF alternatives (p<0.0001). GF products are prevalent online, but 5/10 of the surveyed products were significantly more expensive than equivalents in supermarkets.
  
  
  CONCLUSIONS
  There is good availability of GF food in regular and quality supermarkets as well as online, but it remains significantly more expensive. Budget supermarkets which tend to be frequented by patients from lower socioeconomic classes stocked no GF foods. This poor availability and added cost is likely to impact on adherence in deprived groups.
authors: Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK University of Sheffield Medical School, Sheffield, UK.
authors: Mitchell
authors: M
authors: Burden
authors: Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK University of Sheffield Medical School, Sheffield, UK.
authors: Peter D
authors: http://orcid.org/0000-0002-6647-6728
authors: PD
authors: Mooney
authors: University of Sheffield Medical School, Sheffield, UK.
authors: Rebecca J
authors: RJ
authors: Blanshard
authors: University of Sheffield Medical School, Sheffield, UK.
authors: William L
authors: WL
authors: White
authors: University of Sheffield Medical School, Sheffield, UK.
authors: David R
authors: DR
authors: Cambray-Deakin
authors: Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK University of Sheffield Medical School, Sheffield, UK.
authors: David S
authors: DS
authors: Sanders
mesh_terms: D002446:Celiac Disease / Q000178:diet therapy* / Q000191:economics; D003132:Commerce / Q000191:economics; D003365:Costs and Cost Analysis; D055050:Diet, Gluten-Free / Q000191:economics*; D004739:England / Q000453:epidemiology; D005382:Financing, Personal / Q000191:economics*; D005523:Food Supply / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D010349:Patient Compliance / Q000706:statistics & numerical data*
keywords: PUBLIC HEALTH