title: Adherence to a Gluten-Free Diet in Mexican Subjects with Gluten-Related Disorders: A High Prevalence of Inadvertent Gluten Intake.
abstract: BACKGROUND
  The rate of compliance with a gluten-free diet in patients with gluten-related disorders is unknown in most Latin American countries.
  
  
  OBJECTIVE
  To study the adherence to a gluten-free diet of Mexican individuals with celiac disease and nonceliac gluten sensitivity at the time of their first medical and nutritional consultation at a tertiary referral center.
  
  
  METHODS
  A cross-sectional study was performed. A specific questionnaire was used to gather information on demographics, clinical condition, and self-reported adherence to a gluten-free diet, and to determine strict compliance and intentional or inadvertent gluten consumption. All questionnaires were applied by a nutritionist with expertise in gluten-related disorders.
  
  
  RESULTS
  Fifty-six patients with celiac disease and 24 with non-celiac gluten sensitivity were included. Overall, 46 (57.5%) subjects perceived themselves as strictly adherent; however, inadvertent gluten intake was frequent in both celiac disease and non-celiac gluten sensitivity patients (39.2 vs. 33.3%; p = 0.2). Intentional consumption was more prevalent in subjects with celiac disease (48.8 vs. 29.1%; p = 0.048) and individuals with non-celiac gluten sensitivity showed better adherence (37.5 vs. 12.5%; p = 0.035).
  
  
  CONCLUSIONS
  The importance of a gluten-free diet is underestimated by Mexican patients with celiac disease. The role of a team with expertise in gluten-related disorders is essential to identify inadvertent gluten intake.
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Karen Lizzette
authors.initials: KL
authors.lastname: Ramírez-Cervantes
authors.affiliation: Department of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Angélica Viridiana
authors.initials: AV
authors.lastname: Romero-López
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Núñez-Álvarez
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Uscanga-Domínguez
mesh_terms: D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D005260:Female; D005983:Glutens / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D011795:Surveys and Questionnaires
chemical_list: D005983:Glutens