Academic journal article Central European Journal of Public Health

Compliance with Gluten-Free Diet in a Selected Group of Celiac Children in the Slovak Republic

Academic journal article Central European Journal of Public Health

Compliance with Gluten-Free Diet in a Selected Group of Celiac Children in the Slovak Republic

Article excerpt


Celiac disease (CD) is chronic autoimmune disorder of the small intestine which occurs in genetically predisposed people of all ages from middle infancy onward. CD prevalence is from 0.3 to 1.3% of the population (1-3). Genetically, the susceptibility is present in subjects carrying HLA DQ2 and HLA DQ8 (3). Clinical symptoms of active CD include pain and discomfort in the digestive tract, chronic constipation or diarrhoea, growth stunting, anaemia, fatigue, abdominal distention, malabsorption, loss of appetite, and among children failure to grow normally. Child celiac disease usually starts in the infant age. Vitamins, minerals and nutrients deficiencies are often noted in patients with celiac disease due to the reduced ability of the small intestine to properly absorb nutrients from food (4). CD is demanding for treatment, with a lifelong gluten-free (GF) diet. Currently, GF diet is the only effective treatment for celiac disease (5). No medication exists that will prevent damage or prevent the intestine from attacking the gut when the gluten is present. Strict adherence to the GF diet allows the intestines to heal, which usually leads to restoration and resolution of all symptoms in most cases and, depending on how soon the diet is begun, can also eliminate the higher risk of disease connected with CD sequels, which are osteoporosis, anaemia, autoimmune diseases, nutrient deficiency diseases, intestinal cancer and in some cases, sterility (6). The diet can be cumbersome with difficulties to maintain strict recommendations; but failure to comply with the diet may cause relapse of CD.

CD belongs to chronic non-infectious diseases. Chronic diseases are in most cases responsible for significant changes in the quality of life in terms of important clinical, social, psychological, and economic burdens on the patient's family, on the group of parents, caregivers or on the group of relatives (7). In the case of CD, adherence to gluten-free diet is vital for health outcomes and persisting symptoms of CD. Adherence to diet also depends on the type of personality, age of the patients, gender, family and social surrounding (8). When the person is coming into adolescence period, there is social and peer pressure, including an increasing independence from the parents, which can lead to difficulties in adhering to the strict GF diet. There have been several scientific studies taking into account quality of life in the group of CD patients. Some of them focused on adult population (8, 9), while some on children's group (10, 11).

We suppose that it is very important to discover and confirm the extent to which celiac children suffer as a result of the disease. Compared to other chronic disease connected with handicaps (wheelchair, chronic devastating muscular disorders) - CD patients seem to have equal quality of life, comparable to an average population (11). Scientific studies comparing quality of life of patients with the celiac disease have conflicting and different results. Some studies (11-14) confirmed that quality of life was almost on the same level as the general population, other reference studies confirm decreased quality of life, particularly in mental and social areas (15). Taghir et al. (16) confirmed in their study a better quality of life among celiac children with higher compliance with GF diet.

The aim of our study was to compare factors influencing adherence to GF diet and therefore influencing also clinical symptoms of CD in the selected group of celiac children in Slovakia. We compared impact of selected factors on adherence to gluten-free diet and also we described and analysed important food-related activities by using personal questionnaire in the group of parents or caregivers.


We designed cross-sectional observational anonymous questionnaires study. In the sample, we recruited 325 volunteers, parents or caregivers of children at age 9-15 years, with diagnosis of celiac diseases confirmed by ESPGHAN (European Society for Paediatric Gastroenterology Hepatology and Nutrition) criteria (17, 18). …

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