Impact of food distribution practices on school children with coeliac disease and type 1 diabetes mellitus

As school children with concurrent coeliac disease (CD) and type 1 diabetes mellitus (T1DM) are increasingly being diagnosed, the importance of support and management of the child should grow among families as well as school staff is being recognised.[1] Diet management plays an important role in the management of these diseases. Strict adherence to gluten-free diet in CD and lack of security for food, insulin and glucose monitoring in T1DM are challenges in the school setting, particularly in low-resource countries.[2] There has been an increase in the food distribution practices in schools such as cakes, toffees and chocolates on various occasions. Hence, we conducted this study to observe the impact of food distribution practices on children with CD and T1DM in schools in north India. In this single-centre study, children aged 5–14 years with T1DM, CD or both were enrolled from paediatric endocrinology clinic from February to September 2024 in a tertiary-level teaching hospital. A semi-structured questionnaire (that had been validated by pilot testing on small group of patients by expert clinicians) was administered to record responses from children and their parents regarding their attitude towards their special diet, food distribution practices in schools and effect of this on their psychology and compliance with the treatment. Sixty three children (mean age 8 ± 1.2 years; male: female 2:3) were enrolled in the study. Thirty-three (52.4%) children had T1DM, 25 (39.7%) had CD and 5 (7.9%) had both T1DM and CD. It was observed that 95.2% of students were aware of their special dietary needs and all of them bring their own lunches to school. This is noteworthy considering that only 15.8% of schools offer cafeteria services; however, sweets or candies are distributed in all schools during occasions like birthdays or festivals which occur routinely. Twenty nine (46%) parents felt that their child is significantly affected by the food distribution practices in schools. Twenty five (39.5%) parents perceived a minor effect and only 9 parents believed that their child remains unaffected; 68.2% of parents believed that their child does not have concerns about being different from their peers. In contrast, 28.6% of parents expressed minor concerns, while 3.2% of parents felt that their child is extremely worried. Twenty eight (44.4%) parents felt that such school practices result in a significant degree of non-compliance, 22 (35%) perceived a minor impact on compliance and 13 (20.6%) parents thought that school practices do not affect compliance. Most of the children (95.2%) did not experience teasing from their peers regarding their condition, while a small percentage of the children faced minimal teasing. Food distribution practices had a negative impact on physical as well as mental health of children with CD and T1DM. Previous studies also showed that children with CD and/or T1DM face emotional and behavioural difficulties in school environment when adapting with their disease and diet.[3-5] To effectively manage such conditions, it is important that parents and teachers work together to make necessary changes in school practices, so that holistic care of these children can be ensured. Large multicentric studies are required for further understanding this research question. Author contribution All authors have approved the final version of the manuscript to be published. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI)-assisted technology for manuscript preparation The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the preparation of the manuscript and no images were manipulated using AI.