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A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life


A dietary interview performed by expert personnel is the best method to check whether patients with coeliac disease follow a strict gluten-free diet (GFD). We previously developed a score based on four fast and simple questions that can be administered even by non-expert personnel. The aim of the present study is to verify the reliability of our questionnaire in a new cohort of patients. The questionnaire has a five-level score. From March 2008 to January 2011, the questionnaire was administered to 141 coeliac patients on a GFD, who were undergoing re-evaluation. The score obtained was compared with persistence of both villous atrophy and endomysial antibodies (EMA). The rate of lower scores was higher among the patients with persistence of either villous atrophy (Fisher's exact, P < 0·001; test for trend, P < 0·001) or positive EMA (Fisher's exact, P = 0·001; test for trend, P = 0·018). Given that the coeliac patients have been well instructed on what a GFD means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a GFD.

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*Corresponding author: Dr F. Biagi, fax +39 382 502618, email
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1F Biagi , C Klersy , D Balduzzi , et al. (2010) Are we not over-estimating the prevalence of coeliac disease in the general population? Ann Med 42, 557561.

3MJ Grainge , J West , TR Card , et al. (2011) Causes of death in people with celiac disease spanning the pre- and post-serology era: a population-based cohort study from Derby, UK. Am J Gastroenterol 106, 933939.

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10J See & JA Murray (2006) Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin Pract 21, 115.

14A Rubio-Tapia , MW Rahim , JA See , et al. (2010) Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. Am J Gastroenterol. 105, 14121420.

15R Troncone , M Mayer , F Spagnuolo , et al. (1995) Endomysial antibodies as unreliable marker for slight dietary transgressions in adolescents with coeliac disease. J Pediatr Gastroenterol Nutr 21, 6972.

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18S Case (2005) The gluten-free diet: how to provide effective education and resources. Gastroenterology 128, S128S134.

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British Journal of Nutrition
  • ISSN: 0007-1145
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