Servicio de Gastroenterología-Hepatología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain.
Servicio de Gastroenterología-Hepatología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain.
An Pediatr (Engl Ed). 2021 Jun;94(6):377-384. doi: 10.1016/j.anpede.2020.06.012. Epub 2021 May 19.
The following of a strict gluten-free diet (GFD) is essential in the control of coeliac disease. The aim of this study was to determine the adherence to a GFD in coeliac patients and to evaluate the factors that could influence this adherence.
A descriptive observational study was carried out, in which gluten immunogenic peptides (GIP) were determined in faeces using a semi-quantitative method, and the Coeliac Dietary Adherence Test was completed. Sociodemographic and clinical details were collected, and an ad hoc questionnaire was prepared.
Of the 80 patients included, 92.5% were adherent according to the GIP and 86.3% according to Coeliac Dietary Adherence Test (acceptable agreement; Kappa: 0.31, P = .004). The large majority (83.3%) of patients with positive GIP gave negative anti-transglutaminase antibodies in the latest determination. Current age and time of onset were significantly associated with adherence. Those with a positive GIP had a mean age of 5 years more (P = .0001) and were 52 months more on a GFD (P = .025). One quarter of those surveyed considered the diet difficult to follow. Just under two-thirds (60%) considered that the variability in the eating site was an important factor in leading to infringements, with children's parties being the main area where they occurred (66.7%). The lack of variety (61.4%) and the increased cost (98.6%) of gluten-free foods is highlighted.
The adherence to the GFD is generally good. The analysis of GIP helps to detect non-adherent patients that would pass unnoticed in other circumstances. Measures must be established in order to maintain good long-term adherence, taking into account the risk factors and difficulties detected.
严格遵循无麸质饮食（GFD）对于控制乳糜泻至关重要。本研究旨在确定乳糜泻患者对 GFD 的依从性，并评估可能影响其依从性的因素。
进行了一项描述性观察研究，使用半定量方法检测粪便中的麸质免疫肽（GIP），并完成了乳糜泻饮食依从性测试。收集了社会人口统计学和临床详细信息，并准备了一份专门的问卷。
在纳入的 80 名患者中，根据 GIP，92.5%的患者依从，根据乳糜泻饮食依从性测试（可接受的一致性；Kappa：0.31，P=0.004），86.3%的患者依从。大多数（83.3%）GIP 阳性患者最近一次检测抗转谷氨酰胺酶抗体呈阴性。目前的年龄和发病时间与依从性显著相关。GIP 阳性的患者平均年龄大 5 岁（P=0.0001），且接受 GFD 治疗的时间长 52 个月（P=0.025）。接受调查的四分之一患者认为该饮食难以遵循。近三分之二（60%）的人认为饮食地点的变化是导致违规的重要因素，儿童聚会是违规的主要场所（66.7%）。缺乏多样性（61.4%）和无麸质食品成本增加（98.6%）是突出问题。
总体而言，对 GFD 的依从性良好。分析 GIP 有助于发现其他情况下未被注意到的不依从患者。必须制定措施，以维持良好的长期依从性，考虑到发现的危险因素和困难。
