Factors Affecting Compliance to a Gluten-Free Diet in Pediatric Populations with Celiac Disease

Abstract Celiac disease (CD) is a multisystemic autoimmune disorder triggered by gluten, and the only known remedy available for this malady is a gluten-free diet (GFD). Therefore, we performed a systematic review to correlate the influence of different factors in compliance to a GFD. We searched PubMed database, from inception to April 2019. As inclusion criteria we considered population under 18 years, confirmed diagnosis of CD without related comorbidities and the study objective being the factors affecting compliance to a GFD. The variables compared were age, parent's education level, parental knowledge about CD, family type, celiac association membership, quality of life, and perception of difficulties in maintaining a GFD. We identified 1,414 articles, 35 articles were eligible for full text assessment and 12 were included in the study since they studied similar variables. Our work has found some limitations namely a variety of methods to assess GFD compliance, a limiting definition of compliance, a parental bias in data, an absence of standardization in age categories, and a majority of studies being observational in their nature. Age as well as parental knowledge of CD and family type are key factors in pediatric GFD compliance. Nevertheless environmental, social, and family factors were also related with compliance. Further studies are needed to fully disclose the causality relation between these factors and compliance.