Wang Xinyi, Anders Sven, Jiang Zhiqian, Bruce Marcia, Gidrewicz Dominica, Marcon Margaret, Turner Justine M, Mager Diana R
Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Canada.
Department of Resource Economics and Environmental Sociology, University of Alberta, Edmonton, Canada.
J Pediatr Gastroenterol Nutr. 2024 Dec;79(6):1180-1191. doi: 10.1002/jpn3.12398. Epub 2024 Oct 28.
Celiac disease (CD) is an autoimmune gastrointestinal disorder that requires a strict lifelong gluten-free diet (GFD). Gluten-free (GF) foods are more expensive and less readily accessible than gluten-containing foods, contributing to an increased risk for food insecurity (FI). The study aimed to determine associations between GF-FI, sociodemographic risk factors and child dietary adherence and diet quality (DQ).
A 26-item, cross-country online survey was administered through social media to parents of children with CD on the GFD. The survey elicited household and CD child sociodemographic and clinical characteristics (e.g., duration of CD), measures of household FI, child DQ and GFD adherence, and parents' concerns related to GF food. Household GF-FI was evaluated using the validated Hunger Vital Sign™ and the US Department of Agriculture Six-Item Short Form Household Food Security Survey Module.
GF-FI occurred in 47% of households with children with CD with >30% reporting low to very low food security. Sociodemographic risk factors identified included lower income, renters, rural residency, single-parental households, and having children with additional dietary restrictions (p < 0.001). Regardless of FI status, a majority of households reported experiencing significantly higher GF food expenditure. GF-FI was associated with reduced adherence to the GFD, increased consumption of processed GF food, and lower intakes of fresh fruits and vegetables and GF grains among children with CD (p < 0.05).
GF-FI is prevalent in this multiethnic cohort of households with CD children and is associated with worsening DQ and GFD adherence. Policy interventions are urgently needed to address GF-FI.
乳糜泻（CD）是一种自身免疫性胃肠道疾病，需要终身严格遵循无麸质饮食（GFD）。无麸质（GF）食品比含麸质食品更昂贵且更难获得，这增加了粮食不安全（FI）的风险。本研究旨在确定GF-FI、社会人口统计学风险因素与儿童饮食依从性和饮食质量（DQ）之间的关联。
通过社交媒体对采用GFD饮食的CD患儿家长进行了一项包含26个项目的跨国在线调查。该调查收集了家庭和CD患儿的社会人口统计学及临床特征（如CD病程）、家庭FI指标、儿童DQ和GFD依从性，以及家长对GF食品的担忧。使用经过验证的饥饿生命体征™和美国农业部六项简短家庭食品安全调查模块评估家庭GF-FI。
47%的CD患儿家庭存在GF-FI，超过30%的家庭报告粮食安全水平低至极低。确定的社会人口统计学风险因素包括收入较低、租房者、农村居民、单亲家庭以及孩子有其他饮食限制（p < 0.001）。无论FI状况如何，大多数家庭报告GF食品支出显著更高。GF-FI与CD患儿对GFD的依从性降低、加工GF食品消费增加以及新鲜水果、蔬菜和GF谷物摄入量减少有关（p < 0.05）。
GF-FI在这个多民族的CD患儿家庭队列中普遍存在，并且与DQ恶化和GFD依从性降低有关。迫切需要政策干预来解决GF-FI问题。
