Gluten‐free diet adherence in pediatric celiac patients: Evaluating CDAT questionnaire and test for gluten detection in urine

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 78; no. 6; pp. 1310 - 1316
• Main Authors: Mello, Carolina R. Lins e, Silva, Gisélia A. P., Lins, Manuela T. C., Antunes, Margarida M. de C.
• Format: Journal Article
• Language: English
• Published: United States 01-06-2024
• Subjects: Adolescent; celiac disease; Celiac Disease - diagnosis; Celiac Disease - diet therapy; Celiac Disease - urine; Child; Child, Preschool; children compliance; Diet, Gluten-Free; Female; gluten immunogenic peptide; Glutens - urine; Humans; Male; Patient Compliance - statistics & numerical data; Surveys and Questionnaires; celiac disease; adolescent; gluten immunogenic peptide; children compliance
• ISSN: 0277-2116; 1536-4801; 1536-4801
• DOI: 10.1002/jpn3.12180

Objectives
This study aimed to evaluate the contributions of the Adapted Celiac Dietary Adherence Test (CDAT) and the Rapid Urinary Gluten Detection Test (u‐GIP) in assessing gluten‐free diet adherence in children and adolescents with celiac disease.
Methods
Fifty‐four celiac patients from two pediatric gastroenterology outpatient clinics affiliated with university hospitals were evaluated. The original CDAT was adapted for children through a transcultural process, and the original cutoff point was adopted to define adherence. A single examiner carried out the u‐GIP test in fresh urine samples. Sociodemographic and clinical factors and family food security status were also evaluated.
Results
A total of 88.9% of participants (confidence interval [CI]: 77.4–95.8; p<0.001) adhered to the gluten‐free diet, as determined by the adapted CDAT score, while 87.0% (CI: 75.1–94.6; p<0.001) had negative u‐GIP results. Among the 48 children adhering to the CDAT, six exhibited positive u‐GIP results in a urine sample. Of the six nonadherent participants, only one had a positive u‐GIP result. Notably, none of the children and adolescents with celiac disease who tested positive for u‐GIP reported symptoms on the day of testing, and their growth rates remained stable.
Conclusions
Even celiac children and adolescents adhering to the CDAT questionnaire may show a positive u‐GIP in a single measurement without accompanying symptoms or growth impairment. The u‐GIP could be helpful in complementary tests in specific situations, such as for patients who exhibit compliant behavior but still experience symptoms or maintain persistent positive serology.
What is Known
Assessing adherence to a gluten‐free diet is one of the main goals of monitoring patients with celiac disease.
There is still no defined concept or any single method capable of assessing adherence to a gluten‐free diet in children and adolescents with celiac disease.
In the latest consensus of 2022, ESPGHAN recommends a combination of methods.
Recently, the use of gluten immunogenic peptide has been suggested for monitoring patients; however, its contribution is still under discussion.
What is New
Even celiac children and adolescents adhering to the Adapted Celiac Dietary Adherence Test (CDAT) questionnaire may show a positive Rapid Urinary Gluten Detection Test (u‐GIP) in a single measurement without accompanying symptoms or growth impairment.
Likewise, nonadherent children and adolescents to the CDAT questionnaire may not exhibit a positive u‐GIP in a single sample.
High adherence rates to the gluten‐free diet can be observed in low‐income children and adolescents facing food insecurity when they receive regular monitoring through specialized healthcare services.