Diet therapy for celiac disease: problems and limitations

Abstract

Background. Celiac disease is a chronic immune-mediated disorder for which a gluten-free diet is the only treatment. Despite its efficacy, patient adherence remains a challenge, and low compliance is associated with the risk of complications. Adherence to a GFD is complicated by social, economic, and psychological factors.

Objective. To assess efficacy of the gluten-free diet in patients with celiac disease and identify the main problems associated with its compliance.

Material and methods. A two-stage study using an online questionnaire was conducted. Out of 117 respondents, 77 patients with celiac disease (mean age 34 ± 10 years) were selected. Patients were divided into age groups. Adherence, clinical effect, as well as psychological and socio-economic factors were assessed. Statistical analysis included descriptive methods and the χ² test.

Results. Strict adherence to a gluten-free diet was observed in 88.3% of patients, reaching 100% in the group over 45 years of age. A clinical effect was noted in 89.6% of patients, most frequently within the first month of therapy. Worsening of well-being was observed in 25% of patients. Deficiency conditions were frequently identified: anemia (41.6%) and nutrient deficiencies (49.4%). Psychological disorders were noted in 71.4% of patients. Significant socio-economic barriers were identified: high cost and low availability of products, limited product range, social isolation, and difficulties in adhering to the diet outside the home. A significant association was found between younger age and dissatisfaction with the product range (p < 0.01).

Conclusion. Despite high adherence to a gluten-free diet, its maintenance is limited by psychological and socioeconomic factors and is associated with a risk of nutritional deficiencies, which necessitates personalized and dynamic follow-up of patients with celiac disease.