Psychological correlates of gluten-free diet adherence in adults with celiac disease

J Clin Gastroenterol. 2009 Apr;43(4):301-6. doi: 10.1097/MCG.0b013e31816a8c9b.


Goals: To determine whether personality traits and psychological characteristics are related to gluten-free diet (GFD) adherence in an adult population diagnosed with celiac disease (CD).

Background: Little research has examined psychological correlates of adherence to the GFD.

Study: One hundred fifty-seven adults with biopsy-confirmed CD on the GFD for >3 months completed measures of personality and self-reported GFD adherence, provided a blood sample, and participated in an evaluation of GFD adherence conducted by an expert dietician at a clinical care center in a major teaching hospital in Boston, MA.

Results: An expert evaluation of GFD adherence remained the "gold standard" for measuring GFD adherence when compared with self-report and serology. Logistic regression results indicated that the following were independently associated with GFD adherence: conscientiousness (B=-0.04, SE=0.01, P<0.00), values (B=-0.10, SE=0.05, P<0.05), other food intolerances [odds ratio=0.28, 95% confidence interval=0.10-0.78], and CD symptoms (B=0.05, SE=0.02, P<0.03). A model accounting for these associations effectively predicted whether a participant was adherent or nonadherent on the basis of psychological and demographic/disease-specific factors. Successful prediction rates of GFD adherence for the final model were 75.8% for those rated to be adherent with the GFD and 54.5% for those rated to be nonadherent with the GFD.

Conclusions: The model of psychological and demographic/disease-specific characteristics developed can be used to identify patients who may be at risk for poor dietary adherence to provide additional support, education, and encouragement to individuals with CD.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Celiac Disease / physiopathology
  • Diet, Gluten-Free* / psychology
  • Diet, Gluten-Free* / statistics & numerical data
  • Female
  • Food Hypersensitivity
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Compliance / psychology*
  • Predictive Value of Tests
  • Surveys and Questionnaires
  • Young Adult