title: Adherence to gluten-free diet and barriers to adherence in patients with celiac disease.
abstract: BACKGROUND
  While adherence to gluten-free diet (GFD) is essential for effective control of celiac disease, the level of adherence to GFD may vary. We assessed the level of adherence to GFD and identified barriers to adherence in patients with celiac disease.
  
  
  METHODS
  Both treatment-naive and follow up patients with celiac disease were recruited from a celiac disease clinic. All the patients were assessed for symptom improvement using celiac symptom index (CSI), weight, and hemoglobin; adherence to GFD using detailed dietary history and food-labeled quiz questionnaire; identification of barriers to GFD using a self-administered 36-point questionnaire; and quality of life using a standard 36-item short form (SF36) questionnaire.
  
  
  RESULTS
  Among the patients who were already on GFD, only 53.3% maintained an excellent or good level of adherence, which increased to 92.4% at 6 months with repeated counseling. Among the treatment-naive patients, 64.8% maintained either excellent or good compliance at 1 month after first counseling, which increased to 96.3% at 6 months with repeated counseling. The most common barrier to adherence was non-availability of GFD. Certain barriers could be modified with repeated counseling and education. Response to GFD, as measured by CSI, gain in weight, and improvement in hemoglobin, was better in those having either excellent or good compliance to GFD compared to those who remained poorly adherent.
  
  
  CONCLUSIONS
  Repeated counseling increased the level of adherence to GFD.
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors.forename: Preeti
authors.initials: P
authors.lastname: Rajpoot
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors.forename: Aishwairya
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors.forename: S
authors.initials: S
authors.lastname: Harikrishnan
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors.forename: Bhaskar J
authors.initials: BJ
authors.lastname: Baruah
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors.forename: Vineet
authors.initials: V
authors.lastname: Ahuja
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India. govindmakharia@gmail.com.
authors.forename: Govind K
authors.initials: GK
authors.lastname: Makharia
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000178:diet therapy* / Q000503:physiopathology / Q000523:psychology*; D055050:Diet, Gluten-Free / Q000706:statistics & numerical data*; D037001:Directive Counseling; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D061212:Memory, Episodic; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult
keywords: Adherence; Barriers; Celiac symptom index; Compliance; Quality of life