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

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

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Department of Gastroenterology, Beth Israel Deaconess Medical Center (BIDMC), The Celiac Center, Harvard Medical School, Northeastern University, Boston, MA02215-5491 , USA.



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).


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


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.


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.


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.

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