Adherence to the gluten free diet and health related quality of life in an ethnically diverse pediatric population with Celiac Disease
Celiac disease (CD) is an autoimmune disease that requires life-long adherence to a gluten-free diet (GFD). Adherence to the GFD in childhood may be poor and adversely influence health related quality of life (HRQOL). The study purpose was to determine socio-demographic and socio-economic factors influencing adherence to the GFD and HRQOL in a multi-ethnic cohort of youth with CD.Methods:
A multi-site (Edmonton, Hamilton, Toronto) study examining child-parent HRQOL in youth with CD (n=243) and /or mild gastrointestinal complaints (GI-CON; n = 148) was conducted. Socio-demographic (age, child-parental age/education/ethnicity/place of birth), anthropometric (weight, height, BMI), disease (diagnosis, age at diagnosis, duration, Marsh score, serology), household characteristics (income, family size, region, number of children/total household size), HRQOL (Peds TM4.0/Kindl and CDDUX), GI Complaints (PedsQLTM:Gastrointestinal Symptom Scale [GSS]) and gluten intake were measured.Results:
Younger age (<10 years), non-Caucasian ethnicity (parent/child) and presence of GI symptoms were associated with the highest rates of adherence to the GFD in CD children (p < 0.05). CD children (parent/child) had higher HRQOL (average, composite domains) than GI-CON (p < 0.05), but CD children were comparable to healthy children. Lack of GI symptoms, non-Caucasian ethnicity and age (<10 yrs) were associated with increased HRQOL in composite/average domains for CD (p < 0.05).Conclusions:
Child-parent perceptions of HRQOL in a multiethnic population with CD are comparable to healthy reference populations, but significantly higher than in parent/child GI-CON. Adherence to the GFD in ethnically diverse youth with CD was related to GI symptoms, age of the child and ethnicity of the parent-child.