Challenges in adhering the gluten-free diet
DOI:
https://doi.org/10.33448/rsd-v11i2.26008Keywords:
Challenges; Dietary adherence; Gluten-free.Abstract
The gluten-free diet is recurrently used as a strategy for the treatment of various diseases. However, the restrictions caused by it make it challenging, leading to high percentages of non-adherence. Thus, the present study aims to discuss the various factors that could impair adherence to a gluten-free diet. In this regard, a qualitative bibliographic review was conducted with the descriptors diet, gluten-free, diet adherence, treatment adherence, and challenges, in the following databases Scielo, Pubmed, Science.gov, Scopus, and Google School. Several sources were found for non-adherence to the gluten-free diet, among them: insufficient information of the consumer and food handlers, inadequacies in labels and lack of knowledge in reading them, cross-contamination, and high cost of gluten-free food, lack of availability and access to these foods and unpleasant sensory characteristics, in addition to other aspects of an individual and social nature. In this light, the variety of factors interfering in the adherence and the need for individualized care as an instrument of monitoring adherence are evident, so that assertive interventions can be applied. Moreover, further studies should focus on interventions to improve the aspects addressed and, therefore, the autonomy of these people who need to follow a gluten-free diet.
References
Akobeng, A. K., & Thomas, A. G. (2008). Systematic review: tolerable amount of gluten for people with coeliac disease. Alimentary Pharmacology & Therapeutics. Artigo de K. A. Bascuñán (2017). Celiac disease: understanding the gluten-free diet. European journal of nutrition, 56(2), 449–459. https://doi.org/10.1111/J.1365-2036.2008.03669.X
Antún, M. C., González, V. B., de Ruggiero, M., Lava, M. Del P., Naranja, K., Alonso, N., & Pedemonti, B. (2017). Factores que inciden en la adherencia a la dieta libre de gluten en adultos celíacos de la Ciudad Autónoma de Buenos Aires. Diaeta, 35(161), 10–18. http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1852-73372017000400003&lng=es&nrm=iso&tlng=es
Bengtsson, M. (2016). How to plan and perform a qualitative study using content analysis. NursingPlus Open, 2, 8–14. https://doi.org/10.1016/J.NPLS.2016.01.001
Borin Da Cunha, M., Kobal, D., & Schneider, G. (2018). O Glúten em Questão. Química nova na escola. 40, 59–64. https://doi.org/10.21577/0104-8899.20160105
Case, S. (2005). The gluten-free diet: How to provide effective education and resources. Gastroenterology. Artigo de Z. Lu (2018). Gluten-free living in China: The characteristics, food choices and difficulties in following a gluten-free diet – An online survey. Appetite, 127, 242–248. https://doi.org/10.1053/J.GASTRO.2005.02.020
Codex Alimentarius Comission. (2008). Draft Revised Standard for Foods for Special Dietary Use for PersonsIntolerant to Gluten. http://www.jhnfa.org/CCNFSDU07.pdf
Cozzolino, S. M. F. (2016). Biodisponibilidade de nutrientes. Editora Manole.
Demirkesen, I., & Ozkaya, B. (2020). Recent strategies for tackling the problems in gluten-free diet and products. Critical Reviews in Food Science and Nutrition. 1-27. Advance online publication. https://doi.org/10.1080/10408398.2020.1823814
Dimidi, E., Kabir, B., Singh, J., Ageridou, A., Foster, C., Ciclitira, P., Dubois, P., & Whelan, K. (2021). Predictors of adherence to a gluten-free diet in celiac disease: Do knowledge, attitudes, experiences, symptoms, and quality of life play a role? Nutrition, 90, 111-249. https://doi.org/10.1016/J.NUT.2021.111249
Domínguez, J. (2017). Sobre las “bondades” de los alimentos sin gluten. Revista Cubana de Alimentación y Nutrición. 27(2), 483-487. https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=80177
do Nascimento, A. B., Fiates, G. M. R., dos Anjos, A., & Teixeira, E. (2014). Gluten-free is not enough--perception and suggestions of celiac consumers. International Journal of Food Sciences and Nutrition. Artigo de I. Demirkesen (2020). Recent strategies for tackling the problems in gluten-free diet and products. Critical Reviews in Food Science and Nutrition. 1-27. Advance online publication. https://doi.org/10.3109/09637486.2013.879286
Dowd, A. J., Tamminen, K. A., Jung, M. E., Case, S., Mcewan, D., & Beauchamp, M. R. (2014). Motives for adherence to a gluten-free diet: a qualitative investigation involving adults with coeliac disease. Journal of Human Nutrition and Dietetics : The Official Journal of the British Dietetic Association. Artigo de H. Muhammad (2019). Identifying and improving adherence to the gluten-free diet in people with coeliac disease. Proceedings of the Nutrition Society, 78(3), 418–425. https://doi.org/10.1111/JHN.12203
Dunn, C., House, L., & Shelnutt, K. P. (2014). Consumer Perceptions of Gluten-Free Products and the Healthfulness of Gluten-Free Diets. Undefined. Artigo de D. Khoury (2018). A Review on the Gluten-Free Diet: Technological and Nutritional Challenges. Nutrients, 10(10), 1410. https://doi.org/10.1016/J.JNEB.2014.04.280
Ellaway, A., & Macintyre, S. (2000). Shopping for food in socially contrasting localities. British Food Journal. Artigo de H. Muhammad (2017). Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling. Nutrients, 9(7), 705. https://doi.org/10.1108/00070700010310632/FULL/XML
Falcomer, A. L., Santos Araújo, L., Farage, P., Santos Monteiro, J., Yoshio Nakano, E., & Puppin Zandonadi, R. (2018). Gluten contamination in food services and industry: A systematic review. Critical Reviews in Food Science and Nutrition. 60(3), 479-493. https://doi.org/10.1080/10408398.2018.1541864
Farage, P., de Medeiros Nóbrega, Y. K., Pratesi, R., Gandolfi, L., Assunção, P., & Zandonadi, R. P. (2017). Gluten contamination in gluten-free bakery products: a risk for coeliac disease patients. Public Health Nutrition, 20(3), 413–416. https://doi.org/10.1017/S1368980016002433
Farage, P., Zandonadi, R. P., Gandolfi, L., Pratesi, R., Falcomer, A. L., Araújo, L. S., Nakano, E. Y., & Ginani, V. C. (2019). Accidental Gluten Contamination in Traditional Lunch Meals from Food Services in Brasilia, Brazil. Nutrients, 11(8), 1924. https://doi.org/10.3390/NU11081924
Garnweidner-Holme, L., Sende, K., Hellmann, M., Henriksen, C., Lundin, K. E. A., Myhrstad, M. C. W., & Telle-Hansen, V. H. (2020). Experiences of managing a gluten-free diet on multiple levels of society: a qualitative study. BMC Nutrition, 6(1), 65. https://doi.org/10.1186/S40795-020-00390-3
Gutowski, E. D., Weiten, D., Green, K. H., Rigaux, L. N., Bernstein, C. N., Graff, L. A., Walker, J. R., Duerksen, D. R., & Silvester, J. A. (2020). Can individuals with celiac disease identify gluten-free foods correctly? Clinical Nutrition ESPEN, 36, 82-90. https://doi.org/10.1016/J.CLNESP.2020.01.012
Halmos, E. P., Deng, M., Knowles, S. R., Sainsbury, K., Mullan, B., & Tye-Din, J. A. (2018). Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease. Alimentary Pharmacology & Therapeutics, 48(1), 78–86. https://doi.org/10.1111/APT.14791
Hanci, O., & Jeanes, Y. M. (2019). Are gluten-free food staples accessible to all patients with coeliac disease? Frontline Gastroenterology, 10(3), 222–228. https://doi.org/10.1136/FLGASTRO-2018-101088
Hosseini, S. M., Soltanizadeh, N., Mirmoghtadaee, P., Banavand, P., Mirmoghtadaie, L., & Shojaee-Aliabadi, S. (2018). Gluten-free products in celiac disease: Nutritional and technological challenges and solutions. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 23(1), 109. https://doi.org/10.4103/JRMS.JRMS_666_18
Jamieson, J. A., & Gougeon, L. (2019). Adults following a gluten-free diet report little dietary guidance in a pilot survey exploring relationships between dietary knowledge, management, and adherence in Nova Scotia, Canada. Nutrition Research, 66, 107–114. https://doi.org/10.1016/J.NUTRES.2019.02.005
Khoury, D. el, Balfour-Ducharme, S., & Joye, I. J. (2018). A Review on the Gluten-Free Diet: Technological and Nutritional Challenges. Nutrients, 10(10), 1410. https://doi.org/10.3390/nu10101410
Kim, H. S., Patel, K. G., Orosz, E., Kothari, N., Demyen, M. F., Pyrsopoulos, N., & Ahlawat, S. K. (2016). Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014. JAMA Internal Medicine, 176(11), 1716–1717. https://doi.org/10.1001/JAMAINTERNMED.2016.5254
Lei n. 10.674, de 16 de maio de 2003 (2003). Obriga a que os produtos alimentícios comercializados informem a presença de glúten, como medida preventiva e de controle da doença celíaca. Brasília, DF. https://doi.org/10.674
Leinonen, H., Kivelä, L., Lähdeaho, M.-L., Huhtala, H., Kaukinen, K., & Kurppa, K. (2019). Daily Life Restrictions are Common and Associated with Health Concerns and Dietary Challenges in Adult Celiac Disease Patients Diagnosed in Childhood. Nutrients, 11(8), 1718. https://doi.org/10.3390/NU11081718
Løvik, A., Skodje, G., Bratlie, J., Brottveit, M., & Lundin, K. E. A. (2017). Diet adherence and gluten exposure in coeliac disease and self-reported non-coeliac gluten sensitivity. Clinical Nutrition, 36(1), 275–280. https://doi.org/10.1016/J.CLNU.2015.11.017
Lu, Z., Zhang, H., Luoto, S., & Ren, X. (2018). Gluten-free living in China: The characteristics, food choices and difficulties in following a gluten-free diet – An online survey. Appetite, 127, 242–248. https://doi.org/10.1016/J.APPET.2018.05.007
MacCulloch, K., & Rashid, M. (2014). Factors affecting adherence to a gluten-free diet in children with celiac disease. Paediatrics & Child Health. Artigo de H. Leinonen (2019). Daily Life Restrictions are Common and Associated with Health Concerns and Dietary Challenges in Adult Celiac Disease Patients Diagnosed in Childhood. Nutrients, 11(8), 1718. https://doi.org/10.1093/PCH/19.6.305
Madden, A. M., Riordan, A. M., & Knowles, L. (2016). Outcomes in coeliac disease: a qualitative exploration of patients’ views on what they want to achieve when seeing a dietitian. Journal of Human Nutrition and Dietetics, 29(5), 607–616. https://doi.org/10.1111/JHN.12378
Meyer, S., & Rosenblum, S. (2017). Activities, Participation and Quality of Life Concepts in Children and Adolescents with Celiac Disease: A Scoping Review. Nutrients, 9(9), 929. https://doi.org/10.3390/NU9090929
Muhammad, H., Reeves, S., Ishaq, S., Mayberry, J., & Jeanes, Y. M. (2017). Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling. Nutrients, 9(7), 705. https://doi.org/10.3390/NU9070705
Muhammad, H., Reeves, S., & Jeanes, Y. M. (2019). Identifying and improving adherence to the gluten-free diet in people with coeliac disease. Proceedings of the Nutrition Society, 78(3), 418–425. https://doi.org/10.1017/S002966511800277X
Olsson, C., Lyon, P., Hörnell, A., Ivarsson, A., & Sydner, Y. M. (2009). Food that makes you different: the stigma experienced by adolescents with celiac disease. Qualitative Health Research. Artigo de I. Demirkesen (2020). Recent strategies for tackling the problems in gluten-free diet and products. Critical Reviews in Food Science and Nutrition. 1-27. https://doi.org/10.1177/1049732309338722
Oyarzún, A., Nakash, T., Ayala, J., Lucero, Y., & Araya, M. (2015). Following Gluten Free Diet: Less Available, Higher Cost and Poor Nutritional Profile of Gluten-Free School Snacks. International Journal of Celiac Disease. Artigo de K. A. Bascuñán (2017). Celiac disease: understanding the gluten-free diet. European journal of nutrition, 56(2), 449–459. https://doi.org/10.12691/IJCD-3-3-3
Paganizza, S., Zanotti, R., D’Odorico, A., Scapolo, P., & Canova, C. (2019). Is adherence to a gluten-free diet by adult patients with celiac disease influenced by their knowledge of the gluten content of foods? Gastroenterology Nursing, 42(1), 55–64. https://doi.org/10.1097/SGA.0000000000000368
Rostami, K., Bold, J., Parr, A., & Johnson, M. W. (2017). Gluten-Free Diet Indications, Safety, Quality, Labels, and Challenges. Nutrients, 9(8), 846. https://doi.org/10.3390/NU9080846
Sainsbury, K., & Marques, M. M. (2018). The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis. Appetite, 120, 578–588. https://doi.org/10.1016/J.APPET.2017.10.017
Sant´Ana, W. P., & Lemos, G. C. (2020). Metodologia científica: a pesquisa qualitativa nas visões de Lüdke e André. Revista eletrônica Científica Ensino Interdisciplinar, 4(12), 531–541. http://35.238.111.86:8080/jspui/handle/123456789/488
Schultz, M., Shin, S., & Coppell, K. J. (2017). Awareness of coeliac disease among chefs and cooks depends on the level and place of training. Asia Pacific Journal of Clinical Nutrition, 26(4), 719-724. https://doi.org/10.6133/apjcn.072016.03
Silvester, J. A., Weiten, D., Graff, L. A., Walker, J. R., & Duerksen, D. R. (2016). Is it gluten-free? Relationship between self-reported gluten-free diet adherence and knowledge of gluten content of foods. Nutrition (Burbank, Los Angeles County, Calif.), 32(7–8), 777-783. https://doi.org/10.1016/J.NUT.2016.01.021
Singh, J., & Whelan, K. (2011). Limited availability and higher cost of gluten-free foods. Journal of Human Nutrition and Dietetics. Artigo de D. Khoury (2018). A Review on the Gluten-Free Diet: Technological and Nutritional Challenges. Nutrients, 10(10), 1410. https://doi.org/10.1111/J.1365-277X.2011.01160.X
Terazono, E. (2017). Healthy appetites drive jump in sales of gluten-free foods | Financial Times. https://www.ft.com/content/4ec0f2f2-2c0a-11e7-9ec8-168383da43b7
Tovoli, F., Masi, C., Guidetti, E., Negrini, G., Paterini, P., & Bolondi, L. (2015). Clinical and diagnostic aspects of gluten related disorders. World Journal of Clinical Cases: WJCC, 3(3), 275-284. Artigo de D. el Khoury (2018). A Review on the Gluten-Free Diet: Technological and Nutritional Challenges. Nutrients, 10(10), 1410. https://doi.org/10.12998/WJCC.V3.I3.275
Villafuerte-Galvez, J., Vanga, R. R., Dennis, M., Hansen, J., Leffler, D. A., Kelly, C. P., & Mukherjee, R. (2015). Factors governing long-term adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics. Artigo de H. Muhammad (2017). Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling. Nutrients, 9(7), 705. https://doi.org/10.1111/APT.13319
Wieser H. (2007). Chemistry of gluten proteins. Food microbiology. Artigo de D. el Khoury (2018) A Review on the Gluten-Free Diet: Technological and Nutritional Challenges. Nutrients, 10(10), 1410. https://doi.org/10.1016/j.fm.2006.07.004
Wieser, H., Ruiz-Carnicer, Á., Segura, V., Comino, I., & Sousa, C. (2021). Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease. Nutrients, 13(7), 2274. https://doi.org/10.3390/NU13072274
Wolf, R. L., Morawetz, M., Lee, A. R., Koch, P. A., Contento, I. R., Zybert, P., Green, P. H. R., & Lebwohl, B. (2020). A Cooking-Based Intervention Promotes Gluten-Free Diet Adherence and Quality of Life for Adults with Celiac Disease. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association, 18(11), 2625–2627. https://doi.org/10.1016/J.CGH.2019.09.019
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