Measuring the Risk of Gluten Exposure: Development of the Gluten Exposure Risk Assessment in Pediatric Patients

Area of Science:

• Pediatric Gastroenterology
• Clinical Psychology
• Dietary Adherence Research

Background:

• Celiac Disease (CeD) management necessitates a strict gluten-free diet (GFD).
• Assessing GFD adherence and identifying gluten exposure risks in pediatric CeD patients is challenging.
• No validated screening tools currently exist for pediatric gluten exposure risk.

Purpose of the Study:

• To develop and validate a screening measure for assessing gluten exposure risk in pediatric CeD patients.
• To provide a tool for caregivers to evaluate potential gluten exposure.
• To identify children who may require further intervention to manage their GFD.

Main Methods:

• The Gluten Exposure Risk Assessment (GERA) was developed through a modified Delphi process.
• Psychometric properties, factor structure, and validity were examined in caregivers of pediatric CeD patients.
• Confirmatory factor analysis (CFA) and test-retest reliability were used to validate the final measure.

Main Results:

• An initial 134 items were refined to a 10-item measure (1 screening question, 9 validated items) across two domains (Home, Outside).
• Psychometric and CFA data from 484 caregivers supported the measure's structure.
• Validation in an independent sample (N=369) confirmed the factor structure and reliability (CFI = 0.96, TLI = 0.95, RMSEA = 0.06).

Conclusions:

• The Gluten Exposure Risk Assessment (GERA) is a validated caregiver-completed screening tool for assessing gluten exposure risk in pediatric CeD.
• GERA assists in identifying children at risk for gluten exposure despite a GFD.
• This tool can guide clinical decisions regarding interventions for improved GFD adherence.