Factors That Affect Compliance to Gluten Free Diet by Adult Celiac Disease Patients at King Khaled University Hospital in Riyadh City

This is a cross-sectional study which was carried out to investigate the factors that affect compliance to GFD by adult CD patients aged 18+ years at King Khaled University Hospital (KKUH) in Riyadh city. The study investigated patient's compliance to GFD, the factors that affect their compliance to GFD, and assessed their nutritional status. Patients with biopsy proven CD referred from Gastroenterology clinic to the Endoscopy unit at KKUH for follow up were recruited. The patients were interviewed using structured questionnaire which included questions about demographic data and about their compliance to GFD. Also, the patients were asked about their intake during the last 24 hours. Weight, height, and triceps fat fold were measured. Patients' blood tests data were reviewed and reported from the Laboratory department at KKUH. The results showed that 39% of the patients were following GFD while 61% were not following the diet. The patients' educational level and family monthly income were significantly related to compliance of the patients to GFD, where the complying group had a higher educational level and more income than those not complying. From nutritional point, weight, height, and BMI of the patients following GFD were lower compared to the group not following GFD with no significant difference. Triceps fat fold was significantly lower in complying group than non complying group. For the intake of energy, fat, protein, and CHO there was no significant difference between the two groups but complying group had a lower intake than non complying group. Similarly, the intake of micronutrients was lower in the complying group with no significant difference except for folate where the intake of complying group is more than non complying. The means of laboratory tests were approximately the same between compliers and non compliers but in female CD patients, serum level of iron and ferritin was higher in the complying group than non complying. Heamoglobin and hematocrit were lower in the complying group. Serum level of RBCs was significantly lower in the complying group. Total knowledge score shows that only 12.9% of the patients had a good knowledge score and 45.5% had fair knowledge score. In addition, the distribution of CD patients according to their levels of knowledge scores for different knowledge items shows that majority of the patients had a good knowledge about CD definition, its symptoms, and its treatment. Less than half of the patients had a poor knowledge about gluten and GF foods. Mean knowledge score was significantly higher in the complying group than non complying but it was lower in the group with positive sensitivity test than in the group with negative sensitivity test with no significant difference. The study found that the patients who followed GFD had more knowledge about CD and GFD than the patients who are not following GFD. The dietitian was the most identified source of instructions about GFD by the complying group while the physician was most identified by the non complying group. The internet was the most identified source of information about GFD by both groups. Most patients found it difficult to follow GFD and they had health improvement after following GFD. Also, majority of the patients had difficulty to follow GFD at social events and during travel. There was a significant relation between GF food availability at different places and compliance where supermarket had the highest frequency among all places. Majority of the complying patients found no difficulty in cooking GF dishes and 70% of the patients rarely find gluten listed on food items. The results indicated that the most common reasons for not following GFD were: Following GFD is difficult, non availability of GF foods, dislike the taste of GF foods, following GFD is boring, and lack of knowledge. In addition, confusing food labeling and high prices of GF foods were the major barriers to compliance. It can be summarized that compliance is significantly affected by family monthly income, patient's educational level, knowledge about GFD, and availability of GF food. Also, compliance with GFD affects nutritional status, level of biochemical parameters, and dietary intake