Global Prevalence of Adherence to Gluten-Free Diet in Patients With Celiac Disease: A Systematic Review and Meta-Analysis.
Shubham Mehta, Ashish Chauhan, Dwarakanathan Vignesh et al.
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In 30 seconds
This systematic review and meta-analysis estimated adherence to a gluten-free diet (GFD) among people with celiac disease who had followed the diet for at least 1 year. Across 69 studies and 27,641 participants, pooled adherence was 64% (95% CI 59%-69%) by objective assessment and 74% (95% CI 69%-79%) by self-report. Estimates varied by assessment method: 65% with standardized dietitian evaluation, 57% with the celiac dietary adherence test, and 75% with the BIAGI score. The authors conclude that about one in three patients does not maintain good adherence.
Key findings
- Pooled adherence by objective methods was 64% (95% CI 59%-69%), compared with 74% (95% CI 69%-79%) by self-report.
- Adherence estimates differed by objective measure: 65% (95% CI 57%-73%) by dietitian evaluation, 57% (95% CI 50%-64%) by the celiac dietary adherence test, and 75% (95% CI 65%-83%) by BIAGI score.
- Adherence rates did not differ significantly by time or participant age; assessment method affected rates in univariate metaregression.
- The highest adherence rates were reported in European and North American countries.
Why it matters
A gluten-free diet is standard care for celiac disease, yet pooled estimates indicate that a substantial proportion of patients do not maintain good adherence. The difference between objective and self-reported estimates also shows that adherence rates depend on how they are measured. These findings underscore the importance of assessing dietary adherence and the need for strategies to support it.
What to keep in mind
Adherence estimates varied by assessment method, limiting direct comparability across studies.