Uncovering the Concerns and Needs of Individuals with Celiac Disease: A Cross-Sectional Study

Maialen Vázquez-Polo, Virginia Navarro, Idoia Larretxi, Gesala Perez-Junkera, Arrate Lasa, Silvia Matias, Edurne Simon, Itziar Churruca, Maialen Vázquez-Polo, Virginia Navarro, Idoia Larretxi, Gesala Perez-Junkera, Arrate Lasa, Silvia Matias, Edurne Simon, Itziar Churruca

Abstract

The treatment for celiac disease (CD) involves a strict gluten-free diet, which can be challenging and lead to questions for patients. Pinpointing these uncertainties can enable the creation of efficient educational resources. In this study, a questionnaire was specifically designed to gain insights into the knowledge, concerns, and needs of individuals with CD and their supporters. The questionnaire was distributed through the Instagram social network and received adequate responses from 300 participants, 258 (86%) being female and 152 (50.7%) falling in the age range of 25-44 years. The concerns of individuals with celiac disease and celiac supporters were rated on a 1-4 scale, with a mean score of 3.5 indicating significant concern. A total of 255 (85%) of all participants expressed that their principal concern was the social limitations they faced, such as difficulties in eating out and sharing food with others. Every participant evaluated their overall disease knowledge, averaging at 2.92 out of 4, indicating a reasonable level of awareness. When asked if they believed that improving general knowledge about CD in the general population would enhance their quality of life, the vast majority responded affirmatively. This finding underscores the importance of not only educating individuals with CD but also reaching out to the wider population, especially those who have a direct impact on the daily lives of individuals with CD, such as family members, friends, and food service providers.

Keywords: celiac disease; gluten-free diet; health education; nutritional education.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Husby S., Koletzko S., Korponay-Szabó I., Kurppa K., Mearin M.L., Ribes-Koninckx C., Shamir R., Troncone R., Auricchio R., Castillejo G., et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J. Pediatr. Gastroenterol. Nutr. 2020;70:141–156. doi: 10.1097/MPG.0000000000002497.
    1. King J.A., Jeong J., Underwood F.E., Quan J., Panaccione N., Windsor J.W., Coward S., deBruyn J., Ronksley P.E., Shaheen A.A., et al. Incidence of Celiac Disease Is Increasing over Time: A Systematic Review and Meta-analysis. Am. J. Gastroenterol. 2020;115:507–525. doi: 10.14309/ajg.0000000000000523.
    1. Nevoral J. Celiac Disease in Children: What Has Changed? Int. J. Celiac Dis. 2014;2:18–23. doi: 10.12691/ijcd-2-1-6.
    1. Mustalahti K., Catassi C., Reunanen A., Fabiani E., Heier M., McMillan S., Murray L., Metzger M.H., Gasparin M., Bravi E., et al. The prevalence of celiac disease in Europe: Results of a centralized, international mass screening project. Ann. Med. 2010;42:587–595. doi: 10.3109/07853890.2010.505931.
    1. Lebwohl B., Rubio-Tapia A. Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology. 2021;160:63–75. doi: 10.1053/j.gastro.2020.06.098.
    1. Singh P., Arora A., Strand T.A., Leffler D.A., Catassi C., Green P.H., Kelly C.P., Ahuja V., Makharia G.K. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin. Gastroenterol. Hepatol. 2018;16:823–836.e2. doi: 10.1016/j.cgh.2017.06.037.
    1. Stahl M., Li Q., Lynch K., Koletzko S., Mehta P., Gragert L., Norris J.M., Andrén Aronsson C., Lindfors K., Kurppa K., et al. Incidence of Pediatric Celiac Disease Varies by Region. Am. J. Gastroenterol. 2023;118:539–545. doi: 10.14309/ajg.0000000000002056.
    1. Celdir M.G., Jansson-Knodell C.L., Hujoel I.A., Prokop L.J., Wang Z., Murad M.H., Murray J.A. Latitude and Celiac Disease Prevalence: A Meta-Analysis and Meta-Regression. Clin. Gastroenterol. Hepatol. 2022;20:e1231–e1239. doi: 10.1016/j.cgh.2020.09.052.
    1. Rodrigo L., Garrote J.A., Vivas S. Enfermedad celíaca. Med. Clínica. 2008;131:264–270. doi: 10.1016/S0025-7753(08)72247-4.
    1. Caio G., Volta U., Sapone A., Leffler D.A., De Giorgio R., Catassi C., Fasano A. Celiac disease: A comprehensive current review. BMC Med. 2019;17:142. doi: 10.1186/s12916-019-1380-z.
    1. Parsons K., Brown L., Clark H., Allen E., McCammon E., Clark G., Oblad R., Kenealey J. Gluten cross-contact from common food practices and preparations. Clin. Nutr. 2021;40:3279–3287. doi: 10.1016/j.clnu.2020.10.053.
    1. Bascuñán K.A., Vespa M.C., Araya M. Celiac disease: Understanding the gluten-free diet. Eur. J. Nutr. 2017;56:449–459. doi: 10.1007/s00394-016-1238-5.
    1. Rosén A., Ivarsson A., Nordyke K., Karlsson E., Carlsson A., Danielsson L., Högberg L., Emmelin M. Balancing health benefits and social sacrifices: A qualitative study of how screening-detected celiac disease impacts adolescents’ quality of life. BMC Pediatr. 2011;11:32. doi: 10.1186/1471-2431-11-32.
    1. Olsson C., Lyon P., Hörnell A., Ivarsson A., Sydner Y.M. Food that makes you different: The stigma experienced by adolescents with celiac disease. Qual. Health Res. 2009;19:976–984. doi: 10.1177/1049732309338722.
    1. Cadenhead J.W., Wolf R.L., Lebwohl B., Lee A.R., Zybert P., Reilly N.R., Schebendach J., Satherley R., Green P.H.R. Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten-free diet: A cross-sectional, mixed-methods study. J. Hum. Nutr. Diet. 2019;32:311–320. doi: 10.1111/jhn.12638.
    1. Wolf R.L., Lebwohl B., Lee A.R., Zybert P., Reilly N.R., Cadenhead J., Amengual C., Green P.H.R. Hypervigilance to a Gluten-Free Diet and Decreased Quality of Life in Teenagers and Adults with Celiac Disease. Dig. Dis. Sci. 2018;63:1438–1448. doi: 10.1007/s10620-018-4936-4.
    1. Singh P., Dennis M. Eliminating Dietary Gluten: Don’t Be a “Glutton for Punishment”. Dig. Dis. Sci. 2018;63:1374–1375. doi: 10.1007/s10620-018-5010-y.
    1. Germone M., Phu T., Slosky C., Pan Z., Jones A., Stahl M., Mehta P., Shull M., Ariefdjohan M., Liu E. Anxiety and Depression in Pediatric Patients with Celiac Disease: A Large Cross-Sectional Study. J. Pediatr. Gastroenterol. Nutr. 2022;75:181–185. doi: 10.1097/MPG.0000000000003497.
    1. Zingone F., Swift G.L., Card T.R., Sanders D.S., Ludvigsson J.F., Bai J.C. Psychological morbidity of celiac disease: A review of the literature. United Eur. Gastroenterol. J. 2015;3:136–145. doi: 10.1177/2050640614560786.
    1. Slim M., Rico-Villademoros F., Calandre E.P. Psychiatric Comorbidity in Children and Adults with Gluten-Related Disorders: A Narrative Review. Nutrients. 2018;10:875. doi: 10.3390/nu10070875.
    1. Addolorato G., Mirijello A., D’Angelo C., Leggio L., Ferrulli A., Vonghia L., Cardone S., Leso V., Miceli A., Gasbarrini G. Social phobia in coeliac disease. Scand. J. Gastroenterol. 2008;43:410–415. doi: 10.1080/00365520701768802.
    1. Hallert C., Grännö C., Hultén S., Midhagen G., Ström M., Svensson H., Valdimarsson T. Living with coeliac disease: Controlled study of the burden of illness. Scand. J. Gastroenterol. 2002;37:39–42. doi: 10.1080/003655202753387338.
    1. Kameswari S., Kavitha S., Veeraraghavan V.P., Gayathri R. Knowledge and awareness of celiac disease among the dental students. J. Adv. Pharm. Technol. Res. 2022;13:S549–S553.
    1. Dembiński Ł., Mazur A., Dąbrowski M., Jackowska T., Banaszkiewicz A. Knowledge of Medical Students and Medical Professionals Regarding Nutritional Deficiencies in Patients with Celiac Disease. Nutrients. 2021;13:1771. doi: 10.3390/nu13061771.
    1. TaŞKin B., Savlak N. Public awareness, knowledge and sensitivity towards celiac disease and gluten-free diet is insufficient: A survey from Turkey. Food Sci. Technol. 2021;41:218–224. doi: 10.1590/fst.07420.
    1. Young I., Thaivalappil A. A systematic review and meta-regression of the knowledge, practices, and training of restaurant and food service personnel toward food allergies and Celiac disease. PLoS ONE. 2018;13:e0203496. doi: 10.1371/journal.pone.0203496.
    1. Tye-Din J.A. Review article: Follow-up of coeliac disease. Aliment. Pharmacol. Ther. 2022;56((Suppl. 1)):S49–S63. doi: 10.1111/apt.16847.
    1. Bebb J.R., Lawson A., Knight T., Long R.G. Long-term follow-up of coeliac disease—What do coeliac patients want? Aliment. Pharmacol. Ther. 2006;23:827–831. doi: 10.1111/j.1365-2036.2006.02824.x.
    1. Leffler D.A., Edwards-George J., Dennis M., Schuppan D., Cook F., Franko D.L., Blom-Hoffman J., Kelly C.P. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig. Dis. Sci. 2008;53:1573–1581. doi: 10.1007/s10620-007-0055-3.
    1. Riznik P., De Leo L., Dolinsek J., Gyimesi J., Klemenak M., Koletzko B., Koletzko S., Koltai T., Korponay-Szabó I.R., Krencnik T., et al. The Knowledge About Celiac Disease among Healthcare Professionals and Patients in Central Europe. J. Pediatr. Gastroenterol. Nutr. 2021;72:552–557. doi: 10.1097/MPG.0000000000003019.
    1. Paganizza S., Zanotti R., D’Odorico A., Scapolo P., Canova C. Is Adherence to a Gluten-Free Diet by Adult Patients with Celiac Disease Influenced by Their Knowledge of the Gluten Content of Foods? Gastroenterol. Nurs. 2019;42:55–64. doi: 10.1097/SGA.0000000000000368.
    1. Tomlin J., Slater H., Muganthan T., Beattie R.M., Afzal N.A. Parental knowledge of coeliac disease. Inform. Health Soc. Care. 2015;40:240–253. doi: 10.3109/17538157.2014.907806.
    1. Sahin Y., Sevinc E., Bayrak N.A., Varol F.I., Akbulut U.E., Bükülmez A. Knowledge regarding celiac disease among healthcare professionals, patients and their caregivers in Turkey. World J. Gastrointest. Pathophysiol. 2022;13:178–185. doi: 10.4291/wjgp.v13.i6.178.
    1. Kirchherr J., Charles K. Enhancing the sample diversity of snowball samples: Recommendations from a research project on anti-dam movements in Southeast Asia. PLoS ONE. 2018;13:e0201710. doi: 10.1371/journal.pone.0201710.
    1. Perez L. Celicidad. [(accessed on 31 July 2023)]. Available online: .
    1. Al Sarkhy A. Social media usage pattern and its influencing factors among celiac patients and their families. Saudi J. Gastroenterol. 2020;26:99–104. doi: 10.4103/sjg.SJG_495_19.
    1. Chang J.W., Dellon E.S. Challenges and Opportunities in Social Media Research in Gastroenterology. Dig. Dis. Sci. 2021;66:2194–2199. doi: 10.1007/s10620-021-07058-3.
    1. Reich J., Guo L., Groshek J., Weinberg J., Chen W., Martin C., Long M.D., Farraye F.A. Social Media Use and Preferences in Patients with Inflammatory Bowel Disease. Inflamm. Bowel Dis. 2019;25:587–591. doi: 10.1093/ibd/izy280.
    1. Thanawala S.U., Beveridge C.A., Muir A.B., Strobel M.J., Westcott-Chavez A., Serper M., Yang Y.X., Lynch K.L. Hashing out current social media use in eosinophilic esophagitis. Dis. Esophagus. 2021;34:doab059. doi: 10.1093/dote/doab059.
    1. Abreu Paiva L.M., Gandolfi L., Pratesi R., Harumi Uenishi R., Puppin Zandonadi R., Nakano E.Y., Pratesi C.B. Measuring Quality of Life in Parents or Caregivers of Children and Adolescents with Celiac Disease: Development and Content Validation of the Questionnaire. Nutrients. 2019;11:2302. doi: 10.3390/nu11102302.
    1. Alkhayyat M., Qapaja T., Aggarwal M., Almomani A., Abureesh M., Al-Otoom O., Zmaili M., Mansoor E., Abou Saleh M. Epidemiology and risk of psychiatric disorders among patients with celiac disease: A population-based national study. J. Gastroenterol. Hepatol. 2021;36:2165–2170. doi: 10.1111/jgh.15437.
    1. Halmos E.P., Deng M., Knowles S.R., Sainsbury K., Mullan B., Tye-Din J.A. 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;48:78–86. doi: 10.1111/apt.14791.
    1. Marsilio I., Savarino E.V., Barberio B., Lorenzon G., Maniero D., Cingolani L., D’Odorico A., D’Incà R., Zingone F. A Survey on Nutritional Knowledge in Coeliac Disease Compared to Inflammatory Bowel Diseases Patients and Healthy Subjects. Nutrients. 2020;12:1110. doi: 10.3390/nu12041110.
    1. Ainsworth D., Soon J.M. Nutritional knowledge, eating habits and quality of life of coeliac disease patients. Br. Food J. 2023;125:226–241. doi: 10.1108/BFJ-06-2021-0632.
    1. Lee A.R., Lebwohl B., Lebovits J., Wolf R.L., Ciaccio E.J., Green P.H.R. Factors Associated with Maladaptive Eating Behaviors, Social Anxiety, and Quality of Life in Adults with Celiac Disease. Nutrients. 2021;13:4494. doi: 10.3390/nu13124494.
    1. Wieser H., Segura V., Ruiz-Carnicer Á., Sousa C., Comino I. Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review. Nutrients. 2021;13:2244. doi: 10.3390/nu13072244.
    1. Koerner T.B., Cleroux C., Poirier C., Cantin I., La Vieille S., Hayward S., Dubois S. Gluten contamination of naturally gluten-free flours and starches used by Canadians with celiac disease. Food Addit. Contam. Part A Chem. Anal. Control Expo. Risk Assess. 2013;30:2017–2021. doi: 10.1080/19440049.2013.840744.
    1. Thompson T., Simpson S. A comparison of gluten levels in labeled gluten-free and certified gluten-free foods sold in the United States. Eur. J. Clin. Nutr. 2015;69:143–146. doi: 10.1038/ejcn.2014.211.
    1. European Commission Commission Implementing Regulation (EC) No. 828/2014 of 30 July 2014 on the requirements for the provision of information to consumers on the absence or reduced presence of gluten in food. Off. J. Eur. Union. 2014;228:5–8.
    1. Bustamante M., Fernández-Gil M.P., Churruca I., Miranda J., Lasa A., Navarro V., Simón E. Evolution of Gluten Content in Cereal-Based Gluten-Free Products: An Overview from 1998 to 2016. Nutrients. 2017;9:21. doi: 10.3390/nu9010021.
    1. Mearin M.L., Agardh D., Antunes H., Al-Toma A., Auricchio R., Castillejo G., Catassi C., Ciacci C., Discepolo V., Dolinsek J., et al. ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents with Celiac Disease. J. Pediatr. Gastroenterol. Nutr. 2022;75:369–386. doi: 10.1097/MPG.0000000000003540.
    1. Poslt Königová M., Sebalo Vňuková M., Řehořková P., Anders M., Ptáček R. The effectiveness of gluten-free dietary interventions: A systematic review. Front. Psychol. 2023;14:1107022. doi: 10.3389/fpsyg.2023.1107022.

Source: PubMed

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구독하다