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High adherence to a gluten-free diet in adolescents with screening-detected celiac disease
Charlotta Webb1, Anna Myléus, Fredrik Norström
1*Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund †Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå ‡Pediatric Clinic, Norrtälje Hospital, Norrtälje §Department of Clinical and Experimental Medicine, Pediatrics, Faculty of Health Sciences, Linköping University, Pediatrics in Norrköping, Norrköping ¶Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Objectives:
The aim of the study was to evaluate the gluten-free diet (GFD) adherence after 1 year of follow-up in children with screening-detected celiac disease (CD) in a general population.
Methods:
A total of 18,325 twelve-year-olds were invited to participate in a population-based CD screening (Exploring the Iceberg of Celiacs in Sweden), of whom 13,279 participated. In 240 children, CD was detected through elevated anti-tissue transglutaminase antibodies 2 (TG2-IgA) and verified by a small-intestinal biopsy. This substudy included 210 children with TG2-IgA, evaluated both at the initial biopsy occasion and at 1-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n = 193).
Results:
After 1 year, 85% (179/210) had normalized TG2-IgA levels (<5 U/mL). Among those who had >50 U/mL at diagnosis, 25% (16/63) still had elevated TG2-IgA, but for the majority their initial values were more than halved. Most reported a high level of GFD adherence ("always" 82% [158/193] and "often" 16% [30/193]), and 75% [145/193] reported always adhering combined with normalized TG2-IgA. Although reporting that they were always adherent, 13 (6.7%) had not yet normalized their TG2-IgA levels completely; however, a majority of these initially had the highest TG2-IgA levels.
Conclusions:
GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12-year-olds. Almost all of them had normalized serology and reported GFD adherence at the 1-year follow-up. A few adolescents who reported GFD adherence, however, had elevated TG2-IgA levels, suggesting more severe disease and/or nonadherence.
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