{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:32:44Z","timestamp":1787239964891,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T00:00:00Z","timestamp":1596153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Adherence to a gluten-free diet (GFD) is currently the mainstay of treatment strategy for celiac disease (CD). The aim of our study was measuring a GFD adherence in CD patients using two newly validated methods of dietary assessment\u2014Standardized Dietician Evaluation (SDE) and the Celiac Dietary Adherence Test (CDAT). Ninety-two adults with CD were evaluated by a registered dietitian with extensive experience with the use of SDE and CDAT. Duodenal biopsy was performed and blood was drawn for serum anti-endomysial, anti-deamidated gliadin peptide and anti-tissue transglutaminase antibodies in forty four of those patients. The results of CDAT and SDE were very convergent, but SDE scores better correlated with serologic and histologic findings. As many as 24\u201352% of study participants did not adhere well enough to a GFD. Insufficient adherence to a GFD in CD patients is still a significant problem. The knowledge about gluten content in food ingredients and additives is very low among adults with CD. SDE is the most accurate method in assessing compliance with a GFD and is especially helpful in determining hidden sources of gluten. The CDAT may be a fast tool for screening for a GFD adherence in CD patients.<\/jats:p>","DOI":"10.3390\/nu12082300","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T04:15:31Z","timestamp":1596168931000},"page":"2300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Celiac Dietary Adherence Test and Standardized Dietician Evaluation in Assessment of Adherence to a Gluten-Free Diet in Patients with Celiac Disease"],"prefix":"10.3390","volume":"12","author":[{"given":"Katarzyna","family":"G\u0142ady\u015b","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, Medical University of Gdansk, D\u0119binki St. 7, 80-211 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7691-7788","authenticated-orcid":false,"given":"Jolanta","family":"Dardzi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Medical University of Gdansk, D\u0119binki St. 7, 80-211 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Guzek","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Medical University of Gdansk, D\u0119binki St. 7, 80-211 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6476-9095","authenticated-orcid":false,"given":"Krystian","family":"Adrych","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Medical University of Gdansk, D\u0119binki St. 7, 80-211 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylwia","family":"Ma\u0142gorzewicz","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Medical University of Gdansk, D\u0119binki St. 7, 80-211 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S0140-6736(17)31796-8","article-title":"Coeliac disease","volume":"391","author":"Lebwohl","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rostami, K., Bold, J., Parr, A., and Johnson, M.W. (2017). Gluten-free diet indications, safety, quality, labels, and challenges. Nutrients, 9.","DOI":"10.3390\/nu9080846"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1017\/S0029665112000791","article-title":"The safety of oats in the dietary treatment of coeliac disease","volume":"71","author":"Richman","year":"2012","journal-title":"Proc. Nutr. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1046\/j.1365-2036.1996.66237000.x","article-title":"Review article: Management of patients with non-responsive coeliac disease","volume":"10","author":"Howdle","year":"1996","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1159\/000066757","article-title":"Long-term follow-up of celiac adults on gluten-free diet: Prevalence and correlates of intestinal damage","volume":"66","author":"Ciacci","year":"2002","journal-title":"Digestion"},{"key":"ref_6","first-page":"241","article-title":"Quality of life in coeliac disease is determined by perceived degree of difficulty adhering to a gluten-free diet, not the level of dietary adherence ultimately achieved","volume":"20","author":"Barratt","year":"2011","journal-title":"J. Gastrointestin Liver Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/MCG.0000000000000919","article-title":"World Gastroenterology Organisation Global Guidelines: Celiac Disease February 2017","volume":"51","author":"Bai","year":"2017","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_8","unstructured":"Internal Clinical Guidelines Team (UK) (2015). Coeliac Disease: Recognition, Assessment and Management, National Institute for Health and Care Excellence. NICE Guideline, No. 20."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1038\/ajg.2010.10","article-title":"Mucosal Recovery and Mortality in Adults with Celiac Disease after Treatment with a Gluten-Free Diet","volume":"105","author":"Rahim","year":"2010","journal-title":"Am. J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1309\/EVXT-851X-WHLC-RLX9","article-title":"Histologic follow-up of people with celiac disease on a gluten-free diet: Slow and incomplete recovery","volume":"118","author":"Wahab","year":"2002","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.cgh.2008.12.032","article-title":"A simple validated gluten-free diet adherence survey for adults with celiac disease","volume":"7","author":"Leffler","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1053\/j.gastro.2017.05.015","article-title":"Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disea-se and persistent villous atrophy on gluten-free diets: A meta-analysis","volume":"153","author":"Silvester","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1097\/MPG.0000000000001705","article-title":"Adherence to a Gluten-free Diet: Assessment by Dietician Interview and Serology","volume":"66","author":"Mehta","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1053\/j.gastro.2018.12.010","article-title":"AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review","volume":"156","author":"Husby","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"453","DOI":"10.4321\/S1130-01082011000900003","article-title":"Anti-tissue transglutaminase antibodies (IgA and IgG) in both Crohn\u2019s disease and autoimmune diabetes","volume":"103","year":"2011","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1023\/B:DDAS.0000007875.72256.e8","article-title":"IgA and IgG tissue transglutaminase antibody prevalence and clinical significance in connective tissue diseases, inflammatory bowel disease, and primary biliary cirrhosis","volume":"48","author":"Bizzaro","year":"2003","journal-title":"Dig. Dis. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"670","DOI":"10.3945\/ajcn.111.026708","article-title":"Monitoring of gluten-free diet compliance in celiac patients by assessment of gliadin 33-mer equivalent epito-pes in feces","volume":"95","author":"Comino","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1038\/ajg.2016.439","article-title":"Fecal gluten peptides reveal limitations of serological tests and food questionnaires for monito-ring gluten-free diet in celiac disease patients","volume":"111","author":"Comino","year":"2016","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/MPG.0000000000002062","article-title":"Comparison of clinical methods with the faecal gluten immunogenic peptide to assess gluten intake in coeliac disease","volume":"67","author":"Gerasimidis","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/apt.12194","article-title":"Serum I\u2013FABP as marker for enterocyte damage in coeliac disease and its relation to villous atrophy and circulating autoantibodies","volume":"37","author":"Adriaanse","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"921","DOI":"10.3109\/00365521.2013.809598","article-title":"Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: Results from the Continuous National Health and Nutrition Examination Survey 2009-2010","volume":"48","author":"DiGiacomo","year":"2013","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1111\/j.1365-2036.2007.03501.x","article-title":"A prospective comparative study of five measures of gluten-free diet adherence in adults with coeliac disease","volume":"26","author":"Leffler","year":"2007","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1017\/S0007114509301579","article-title":"A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease","volume":"102","author":"Biagi","year":"2009","journal-title":"Br. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1017\/S0007114511007367","article-title":"A score that verifies adherence to a gluten-free diet: A cross-sectional, multicentre validation in real clinical life","volume":"108","author":"Biagi","year":"2012","journal-title":"Br. J. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1007\/s10620-007-0055-3","article-title":"Factors that influence adherence to a gluten-free diet in adults with celiac disease","volume":"53","author":"Leffler","year":"2008","journal-title":"Dig. Dis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1136\/gutjnl-2013-306578","article-title":"BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology. Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology","volume":"63","author":"Ludvigsson","year":"2014","journal-title":"Gut"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/jhn.12638","article-title":"Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten-free diet: A cross-sectional, mixed-methods study","volume":"32","author":"Cadenhead","year":"2019","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_28","first-page":"138","article-title":"Transcultural adaptation and validation of the Celiac Dietary Adherence Test. A simple questionnaire to measure adherence to a gluten-free diet","volume":"108","year":"2016","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Muhammad, H., Reeves, S., Ishaq, S., Mayberry, J., and Jeanes, Y.M. (2017). Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling. Nutrients, 9.","DOI":"10.3390\/nu9070705"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1111\/apt.13725","article-title":"Symptomatic suspected gluten exposure is common among patients with coeliac disease on a gluten-free diet","volume":"44","author":"Silvester","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/SGA.0000000000000368","article-title":"Is Adherence to a Gluten-Free Diet by Adult Patients with Celiac Disease Influenced by Their Knowledge of the Gluten Content of Foods?","volume":"42","author":"Paganizza","year":"2019","journal-title":"Gastroenterol. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/MPG.0000000000002451","article-title":"Celiac Dietary Adherence Test simplifies Determining Adherence to a Gluten-free Diet in Swedish Adolescents","volume":"69","author":"Johansson","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/apt.14791","article-title":"Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease","volume":"48","author":"Halmos","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"410","DOI":"10.15557\/PiMR.2015.0039","article-title":"Difficulties related to compliance with gluten-free diet by patients with coeliac disease living in Upper Silesia","volume":"11","author":"Ferster","year":"2015","journal-title":"Pediatr. Med. Rodz."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1111\/j.1365-2036.2009.03983.x","article-title":"Patient perceptions of the burden of coeliac disease and its treatment in the UK","volume":"29","author":"Whitaker","year":"2009","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1365-277X.2006.00659.x","article-title":"The impact of a gluten-free diet on adults with coeliac disease: Results of a national survey","volume":"19","author":"Zarkadas","year":"2006","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/s12664-015-0607-y","article-title":"Adherence to gluten-free diet and barriers to adherence in patients with celiac disease","volume":"34","author":"Rajpoot","year":"2015","journal-title":"Indian J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.nutres.2019.02.005","article-title":"Adults following a gluten-free diet report little dietary guidance in a pilot survey exploring relationships between dietary knowledge, management, and adherence in Nova Scotia, Canada","volume":"66","author":"Jamieson","year":"2019","journal-title":"Nutr. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.3390\/nu5051585","article-title":"Is dietitian use associated with celiac disease outcomes?","volume":"5","author":"Mahadev","year":"2013","journal-title":"Nutrients"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Hughey, J.J., Ray, B.K., Lee, A.R., Voorhees, K.N., Kelly, C.P., and Schuppan, D. (2017). Self-reported dietary adherence, disease-specific symptoms, and quality of life are associated with healthcare provider follow-up in celiac disease. BMC Gastroenterol., 17.","DOI":"10.1186\/s12876-017-0713-7"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.giec.2006.03.005","article-title":"Monitoring Nonresponsive Patients Who Have Celiac Disease","volume":"16","author":"Krauss","year":"2006","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ejim.2019.07.024","article-title":"No major reduction in bone mineral density after long-term treatment of patients with Celiac Disease","volume":"68","author":"Lundin","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1097\/MCG.0000000000000218","article-title":"Dietary Supplement Use in Patients with Celiac Disease in the United States","volume":"49","author":"Nazareth","year":"2015","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Assor, E., Marcon, M.A., Hamilton, N., Fry, M., Cooper, T., and Mahmud, F.H. (2015). Design of a dietary intervention to assess the impact of a gluten-free diet in a population with type 1 Diabetes and Celiac Disease. BMC Gastroenterol., 15.","DOI":"10.1186\/s12876-015-0413-0"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/8\/2300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:53:12Z","timestamp":1760176392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/8\/2300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,31]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["nu12082300"],"URL":"https:\/\/doi.org\/10.3390\/nu12082300","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,31]]}}}