Food insecurity prevents gluten-free diet adoption, nutritional intake in coeliac disease patients

One in six patients with coeliac disease (CD) do not have a reliable access to a sufficient amount of affordable and nutrition food, a US study has found. This food insecurity negatively affects the adoption of a gluten-free diet (GFD) and the ability to meet recommended daily intake of most micronutrients.

In addition, “[l]ess than one quarter of food-insecure CD patients adhere to a GFD,” the researchers said.

Data from CD patients participating in the US National Health and Nutrition Examination Survey from 2009 to 2014 were analysed in this study. Food insecurity was defined by the US Department of Agriculture 18-Item Standard Food Security Survey Module.

The researchers assessed differences in demographic characteristics of CD patients living with food insecurity and the impact of food insecurity on GFD adoption using survey-weighted logistic regression. They also examined the effect of food insecurity on nutritional intake of macro- and micronutrients using multivariable survey-weighted linear regression.

In the US, food insecurity affects 15.9 percent (95 percent confidence interval [CI], 10.6‒23.1) of CD patients (weighted n=2.9 million, 95 percent CI, 2.2‒3.5 million). These individuals were more likely to be younger, poorly educated nonwhite, and living in poverty and were significantly less likely to adopt a GFD (24.1 percent vs 67.9 percent; p=0.02).

Of note, food insecurity contributed to a lower consumption of protein, carbohydrates, fat, and most vitamins and minerals.

“Food insecurity is a major public health challenge,” the researchers said. “For patients with CD, food insecurity may be particularly detrimental as it threatens the cornerstone of their treatment: adoption of a GFD.”