A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease

Br J Nutr. 2009 Sep;102(6):882-7. doi: 10.1017/S0007114509301579. Epub 2009 Mar 31.


A dietary interview performed by expert personnel is considered to be the most appropriate tool to check whether patients with coeliac disease follow a strict gluten-free diet. However, we currently have no straightforward and non-subjective method for performing such a dietary interview. We therefore developed a fast questionnaire based on four simple questions with a five-level score (0-IV). To verify whether our questionnaire is an efficient tool, we applied it to 168 coeliac patients (126 females and 42 males; mean age 42.4 (SD 12.9) years) on a gluten-free diet (median 82, 25th-75th percentile 50-108, range 15-389 months). The score we obtained was compared with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. A comparison with survival of the patients was also performed. Patients were interviewed over the phone by non-expert personnel. The questionnaire was completed in less than 1 min. The lowest results were significantly more frequent among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Death risk was also significantly correlated with the lowest score results. We conclude that our questionnaire is a reliable and simple method of verifying compliance with a gluten-free diet.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Atrophy
  • Autoantibodies / blood
  • Celiac Disease / diet therapy*
  • Celiac Disease / immunology
  • Celiac Disease / pathology
  • Diet, Gluten-Free / psychology*
  • Duodenum / pathology
  • Epidemiologic Methods
  • Female
  • Humans
  • Intestinal Mucosa / pathology
  • Male
  • Middle Aged
  • Muscle, Striated / immunology
  • Patient Compliance*
  • Surveys and Questionnaires*


  • Autoantibodies