COMPLY-CATeD: Celiac Adherence in Teens Diagnosed: an Italian multicentric study

OBJECTIVES: Gluten-free diet (GFD) is, to date, the only effective therapeutic intervention for coeliac disease (CeD). Evaluation of dietary adherence is of the utmost importance in the management of CeD. However, in the paediatric population, there is limited data concerning the adherence to the GFD in patients diagnosed via bioptic confirmation compared to those diagnosed through the biopsy-sparing method, according to the ESPGHAN 2012 guidelines. In this multicentric study, we investigated dietary adherence in a group of adolescents with CeD, comparing patients diagnosed with the two different diagnostic modalities, and we proposed the validation of an evaluation tool for the GFD compliance in this population. METHODS: A total of 206 patients aged 14-18 years, diagnosed between 2012 and 2019, all with CeD and on a GFD for at least 2 years, were included. Adherence was assessed using the Leffler questionnaire [Celiac Dietary Adherence Test (CDAT)] and the Biagi score. RESULTS: Among participants, 81.1% had been diagnosed through biopsy. No significant difference in Biagi scores was observed between the two groups (P = 0.057). Regarding the CDAT, poor or suboptimal adherence (score: ≥13) was identified in 66 patients diagnosed by biopsy and 12 patients diagnosed by the biopsy-sparing approach (P = 0.362). A multivariate analysis exploring the influence of diagnostic method, age at diagnosis, and education level on CDAT scores did not reach statistical significance (P = 0.1, R2 = 0.031). CONCLUSION: Adherence to a GFD does not differ between adolescents diagnosed by biopsy and those diagnosed through the biopsy-sparing approach, irrespective of age at diagnosis or educational level.