Gastroenterologie
a hepatologie

Adherence to a gluten-free diet in Slovak celiac patients

Slávka Mrosková¹, Beáta Kollárová¹, Sára Lešková Andraščíková², Martina Reľovská¹

+ Affiliation
¹ Fakulta zdravotníckych odborov, Prešovská univerzita, Prešov
² FNsP J. A. Reimana, Prešov

Summary

Background: Celiac dis­ease is a serious autoimmune dis­ease that develops in genetically predisposed individuals after consuming gluten. The only treatment is strict adherence to a gluten-free diet. Since gluten is a component of many foods, meals, semi-finished products and beverages, respecting the principles of a gluten-free diet (GFD) is a challenge for many celiac patients. Aim: The aim of the research was to assess adherence to GFD in adult patients with celiac dis­ease in the Slovak Republic and to assess the influence of selected factors on adherence. Methods: The sample consisted of 213 celiac patients with a mean age of 38 years, where 90.6% were women. Adherence was assessed using the Celiac dietary adherence test (CDAT). We also assessed the incidence of problems with adherence to BD, intensity of discomfort after consuming gluten, and the fear of complications related to gluten intake. Results: The mean CDAT score was 14.78 (SD 4.34, range 7– 29). Good adherence was found in 32.9% of celiac patients, average in 42.7%, and poor in 24.4%. Celiac patients have the greatest problems with respecting GFD when eating in restaurants, at work/ school, and when traveling. Problems with purchasing gluten-free foods (P = 0.017), preparation of gluten-free meals (P = 0.049), and eating with family and friends (P = 0.004) are associated with adherence. Also, a higher intensity of problems after consuming gluten (P = 0.008) and a greater fear of developing complications (P = 0.000) are associated with adherence. Conclusion: Strengthening skills in selecting, purchasing, and preparing gluten-free meals by healthcare professionals and dietitians, as well as increasing awareness of GFD among the general public, can reduce the perception of problems and improve adherence to the diet.

Keywords

adherence pacienta, problems with respecting a gluten-free diet, purchasing gluten-free foods, preparation of gluten-free foods, eating with family, friends

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Literature

1. Vacková Z. Celiac dis­ease in adults. Vnitr Lek 2020; 66(2): 116– 120.
2. Packová B, Kohout P, Gabrovská D. Výživa u celiakie. In: Kohout P, Havel E, Matějovič M et al. (eds). Klinická výživa. Praha: Galén 2021: 599– 609.
3. Bai JC, Ciacci C, Corazza GR et al. World Gastroenterology Organisation Global Guidelines: celiac dis­ease. 2016 [online]. Dostupné z: https:/ / www.worldgastroenterology.org/ guidelines/ celiac-dis­ease/ celiac-dis­ease-english.
4. Singh P, Arora A, Strand TA et al. Global prevalence of celiac dis­ease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16(6): 823– 836.e2. doi: 10.1016/  j. cgh.2017.06.037.
5. Bureš J.  Celiac dis­ease in 2018. Vnitr Lek 2018; 64(6): 602– 610.
6. Bátovský M. Dia­gnostika a liečba celiakie: dnes a zajtra. Gastroent Hepatol 2012; 66(5): 372– 376.
7. Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with coeliac dis­ease. Aliment Pharmacol Ther 2008; 27(11): 1044– 1052. doi: 10.1111/ j. 1365-2036.2008.03669.x.
8. See JA, Kaukinen K, Makharia GK et al. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol 2015; 12(10): 580– 591. doi: 10.1038/ nrgastro.2015.156.
9. Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac dis­ease. Aliment Pharmacol Ther 2009; 30(4): 315– 330. doi: 10.1111/ j. 1365-2036.2009.04053.x.
10. Muhammad H, Reeves S, Jeanes YM. Identifying and improving adherence to the gluten-free diet in people with coeliac dis­ease. Proc Nutr Soc 2019; 78(3): 418– 425. doi: 10.1017/ S002966511800277X.
11. Abu-Janb N, Jaana M. Facilitators and barriers to adherence to gluten-free diet among adults with celiac dis­ease: a systematic review. Hum Nutr Diet 2020; 33(6): 786– 810. doi: 10.1111/ jhn.12754.
12. Xhakollari V, Canavari M, Osman M. Factors affecting consumers‘ adherence to gluten-free diet, a systematic review. Trends Food Sci Technol 2019; 85: 23– 33. doi: 10.1016/  j. tifs.2018.12.00.
13. White LE, Bannerman E, Gillett PM. Coeliac dis­ease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence. J Hum Nutr Diet 2016; 29(5): 593– 606. doi: 10.1111/ jhn.12375.
14. Burger JP, Brouwer B, IntHout J et al. Systematic review with meta-analysis: dietary adherence influences normalization of health-related quality of life in coeliac dis­ease. Clin Nutr 2017; 36(2): 399– 406. doi: 10.1016/ j. clnu.2016. 04.021.
15. Leffler DA, Dennis M, George JBE et al. A simple validated gluten-free diet adherence survey for adults with celiac dis­ease. Clin Gastroenterol Hepatol 2009; 7(5): 530– 536. doi: 10.1016/  j. cgh.2008.12.032.
16. Zarkadas M, Dubois S, MacIsaac K et al. Living with coeliac dis­ease and a gluten-free diet: a Canadian perspective. J Hum Nutr Diet 2013; 26(1): 10– 23. doi: 10.1111/ j. 1365-277X.2012. 01288.x.
17. Simón E, Molero-Luis M, Fueyo-Díaz R et al. The gluten-free diet for celiac dis­ease: critical insights to better understand clinical outcomes. Nutrients 2023; 15(18): 4013. doi: 10.3390/ nu15184013.
18. Real-Delora RE, Chamorro-Aguilerab ME. Adherence to a gluten-free diet in celiac dis­ease patients from Paraguay. Rev Gastroenterol Mex 2023; 88(4): 307– 314. doi: 10.1016/  j. rgmxen.2021.10.011.
19. Mehtab W, Agarwal A, Chauhan A et al. Barriers at various levels of human ecosystem for maintaining adherence to gluten free diet in adult patients with celiac dis­ease. Eur J Clin Nutr 2024; 78(4): 320– 327. doi: 10.1038/ s41 430-024-01399-8.
20. Dimini E, Kabir B, Singh J et al. Predictors of adherence to a gluten-free diet in celiac dis­ease: do knowledge, attitudes, experiences, symptoms, and quality of life play a role? Nutrition 2021; 90: 111249. doi: 10.1016/  j. nut.2021.111249.
21. Gładyś K, Dardzińska J, Guzek M et al. Celiac dietary adherence test and standardized dietician evaluation in assessment of adherence to a gluten-free diet in patients with celiac dis­ease. Nutrients 2020; 12(8): 2300. doi: 10.3390/ nu12082300.
22. Halmos EP, Deng M, Knowles SR et al. Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac dis­ease. Aliment Pharmacol Ther 2018; 48(1): 78– 86. doi: 10.1111/ apt.14791.
23. Kurppa K, Lauronen O, Collin P et al. Factors associated with dietary adherence in celiac dis­ease: a nationwide study. Digestion 2012; 86(4): 309– 314. doi: 10.1159/ 000341416.
24. Dowd AJ, Jung ME. Self-compassion directly and indirectly predicts dietary adherence and quality of life among adults with celiac dis­ease. Appetite 2017; 113: 293– 300. doi: 10.1016/ j. appet.2017.02.023.
25. Makovický P, Samasca G, Freeman HJ et al. Bezlepková diéta v úskalí zákonov: dočkajú sa celiatici konečne zmien v legislatíve? Reviz Posud Lék 2017; 20(2): 65– 73.
26. Estévez V, Ayala J, Vespa C et al. The gluten-free basic food basket: a problem of availability, cost and nutritional composition. Eur J Clin Nutr 2016; 70(10): 1215– 1217. doi: 10.1038/ ejcn.2016.139.
27. Pekárek B, Pekárková B, Hromec J et al. Celiakia –  body mass index u pacientov v čase dia­gnózy a efekt bezlepkovej diéty. Gastroent Hepatol 2014; 68(4): 319– 324.
28. Zákon 447/ 2008 Z. z. o peňažných príspevkoch na kompenzáciu ťažkého zdravotného postihnutia a o zmene a doplnení niektorých zákonov. 2025 [online]. Dostupné z: https:/ / www.slov-lex.sk/ ezbierky/ pravne-pred- pisy/ SK/ ZZ/ 2008/ 447/ .
29. MFSR. Analýza cenového vývoja základných druhov potravín 5/ 2024. 2025 [online]. Dostupné z: https:/ / www.mfsr.sk/ files/ archiv/ 87/ 03_Vlastny-material.pdf.
30. Karmažin B. Potraviny zdraželi a inflácia poskočila nahor. 2024 [online]. Dostupné z: https:/ / nbs.sk/ komentare/ potraviny-zdrazeli-a-inflacia-poskocila-nahor/ .
31. Muhammad H, Reeves S, Ishaq S et al. Adherence to a gluten free diet is associated with receiving gluten free foods on prescription and understanding food labelling. Nutrients 2017; 9(7): 705. doi: 10.3390/ nu9070705.
32. Payette CC, Desjardins C, Lalanne E et al. Exploring challenges faced by adults living with celiac dis­ease: a food literacy perspective. J Hum Nutr Diet 2025; 38(2): e70057. doi: 10.1111/ jhn.70057.