Journal of pediatric gastroenterology and nutrition · 2025
The prevalence and impact of gluten-free food insecurity in pediatric celiac disease.
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Krueger Andrew, Sahay Rashmi D, Gecili Emrah, Henize Adrienne W, Beck Andrew F, Klein Melissa, Mallon Daniel
Аннотация
OBJECTIVES: Celiac disease (CeD) requires lifelong adherence to a gluten-free (GF) diet (GFD), though GF foods are more expensive. This study aimed to: (1) evaluate concordance between GF and general food insecurity (FI) among households with a child with CeD, (2) assess demographic and social factors associated with GF FI, and (3) investigate the impact of GF FI on tissue transglutaminase immunoglobulin A (TTG IgA) decline and GFD adherence.
METHODS: This single-center cohort study included CeD patients less than 18 years old. A de novo survey assessing GF FI, general FI, GFD adherence, social determinants of health, and sociodemographic information was distributed electronically to all CeD patients seen over a 6-year period. Additional clinical information was obtained from the electronic health record for respondents. Time to normalization of TTG IgA was assessed using Kaplan-Meier curves, log-rank tests, and Cox regression models. Independent associations between GF FI and GFD adherence were examined.
RESULTS: A total of 1039 CeD patients from 994 unique households received surveys with a 34.8% response rate. More respondents reported GF FI (26%) than general FI (20%). GF food insecure respondents took significantly longer to achieve TTG IgA normalization (hazard ratio = 0.63, 95% confidence interval 0.44-0.9) than their food secure peers. Furthermore, GF FI was significantly associated with worse GFD adherence and gluten consumption due to transportation barriers, cost, and lack of GF food accessibility (all p < 0.05).
CONCLUSIONS: GF FI should be considered in the routine care of pediatric CeD given its prevalence and impact on TTG IgA normalization and GFD adherence.
METHODS: This single-center cohort study included CeD patients less than 18 years old. A de novo survey assessing GF FI, general FI, GFD adherence, social determinants of health, and sociodemographic information was distributed electronically to all CeD patients seen over a 6-year period. Additional clinical information was obtained from the electronic health record for respondents. Time to normalization of TTG IgA was assessed using Kaplan-Meier curves, log-rank tests, and Cox regression models. Independent associations between GF FI and GFD adherence were examined.
RESULTS: A total of 1039 CeD patients from 994 unique households received surveys with a 34.8% response rate. More respondents reported GF FI (26%) than general FI (20%). GF food insecure respondents took significantly longer to achieve TTG IgA normalization (hazard ratio = 0.63, 95% confidence interval 0.44-0.9) than their food secure peers. Furthermore, GF FI was significantly associated with worse GFD adherence and gluten consumption due to transportation barriers, cost, and lack of GF food accessibility (all p < 0.05).
CONCLUSIONS: GF FI should be considered in the routine care of pediatric CeD given its prevalence and impact on TTG IgA normalization and GFD adherence.