50 - Longitudinal Analysis of Gluten-Free Dietary Adherence and Psychosocial Health in Gluten-Associated Disorders: The UCLA Celiac Collective

Tuesday, October 25, 2022

2:55 PM – 3:05 PM ET

Location: Hall C1

Presenting Author(s)

Anna H. Lee, MD

University of California, Los Angeles
Los Angeles, CA

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Award: Lawlor Resident Award

Anna H. Lee, MD¹, Sonya Dasharathy, MD², Punya Chittajallu, MD², Janelle E. Smith, MS, RD³, Nancee Jaffe, MS, RD², Lucia Chen, MS¹, Jeffrey Lackner, PsyD⁴, Eric Esrailian, MD, MPH¹, Lin Chang, MD¹, Guy A. Weiss, MD⁵
¹University of California, Los Angeles, Los Angeles, CA; ²UCLA, Los Angeles, CA; ³UCLA, Santa Ana, CA; ⁴University at Buffalo, Buffalo, NY; ⁵University of California Los Angeles, Los Angeles, CA

Introduction: Gluten-free diet (GFD), the mainstay of gluten-associated disorder (GAD) treatment, relies on patient adherence to optimize its therapeutic value. Psychological distress and decreased quality of life are associated with GFD non-adherence, but longitudinal assessments of psychosocial health’s impact on dietary adherence are lacking. Our study is the first to explore mental health status and motivational factors (e.g., motivation type, perceived competence), and their connection with longitudinal changes in GFD adherence.

Methods: In our prospective study, we invited patients with self-reported GAD from the UCLA Celiac Collective to complete baseline (2016-2020) and follow-up (2022) surveys. Surveys captured demographics, medical history, and responses to the Celiac Dietary Adherence Test; Celiac Symptom Index; PRO Measurement Information System’s depression, anxiety, sleep disturbance, fatigue, pain, and social satisfaction domains; Celiac Disease Quality of Life; Treatment Self-Regulation Questionnaire for motivation; Perceived Competence Scale; and Health Care Climate Questionnaire for relationship with healthcare provider. Cross-sectional analyses of GFD adherence, the primary outcome, used McNemar’s and Wilcoxon rank-sum tests; the longitudinal analysis assessed changes in GFD adherence from baseline to follow-up with T-tests.

Results: We identified 449 patients with GAD at baseline (87.9% female, mean age 48). Of those patients, 123 completed follow-up. Factors consistently associated with higher GFD adherence at baseline and follow-up were lower scores for disease activity, anxiety, depression, fatigue, pain; and higher competence, autonomous motivation, and social satisfaction. Forty-four patients whose GFD adherence declined over time also saw an increase in disease activity, depression, fatigue; and a decrease in social satisfaction.

Discussion: This is the first longitudinal study to show that intrinsic (or autonomously) motivated GAD patients who perceived themselves to be competent in complying with a GFD achieved better adherence, which in turn was linked to less distress and disease activity. This pattern emerged at both assessment periods and suggests that specific motivational behaviors may drive GFD adherence and its therapeutic value. Providers, whose influence is demonstrated by the positive association seen between patient-provider relationships and adherence, should treat GAD by considering these intrinsic behavioral qualities while addressing mental health disorders.

		Non-Adherence (CDAT ≥ 13)	Adherence (CDAT < 13)	p-value	Worsened Adherence	Improved Adherence	p-value
Celiac Disease Activity (CSI)
	Baseline	45.0 (37.0-51.0)	29.0 (23.0-36.0)	< 0.001	+4.2 (8.3)	-2.8 (8.2)	0.002
	Follow-up	38.5 (36.0-45.5)	32.0 (25.5-36.5)	< 0.001	+4.2 (8.3)	-2.8 (8.2)	0.002
Anxiety (PROMIS-29)
	Baseline	9.0 (6.0-12.0)	6.0 (4.0-8.0)	< 0.001	+1.2 (2.7)	0.0 (3.9)	0.154
	Follow-up	9.0 (6.0-11.0)	7.0 (4.0-9.8)	0.018	+1.2 (2.7)	0.0 (3.9)	0.154
Depression (PROMIS-29)
	Baseline	7.0 (4.2-10.0)	4.0 (4.0-6.0)	< 0.001	+1.1 (2.1)	-0.6 (3.3)	0.014
	Follow-up	7.0 (5.0-9.0)	4.0 (4.0-5.0)	< 0.001	+1.1 (2.1)	-0.6 (3.3)	0.014
Sleep (PROMIS-29)
	Baseline	10.0 (8.0-12.0)	7.0 (5.0-9.0)	< 0.001	+0.4 (2.6)	+0.3 (3.3)	0.842
	Follow-up	9.0 (7.0-11.0)	8.0 (6.0-10.0)	0.185	+0.4 (2.6)	+0.3 (3.3)	0.842
Fatigue (PROMIS-29)
	Baseline	13.0 (9.5-16.0)	8.0 (6.0-10.0)	< 0.001	+1.5 (2.8)	-1.1 (3.2)	< 0.001
	Follow-up	12.0 (10.0-15.0)	8.0 (6.5-10.5)	< 0.001	+1.5 (2.8)	-1.1 (3.2)	< 0.001
Satisfaction with Social Interaction (PROMIS-29)
	Baseline	10.0 (7.0-12.0)	14.0 (12.0-16.0)	< 0.001	-1.0 (3.5)	+1.0 (3.2)	0.019
	Follow-up	10.0 (8.0-12.0)	15.0 (12.0-16.0)	< 0.001	-1.0 (3.5)	+1.0 (3.2)	0.019
Pain (PROMIS-29)
	Baseline	9.0 (5.5-14.0)	4.0 (4.0-8.0)	< 0.001	+0.6 (4.0)	-0.8 (4.0)	0.15
	Follow-up	8.0 (6.8-12.0)	5.0 (4.0-7.2)	< 0.001	+0.6 (4.0)	-0.8 (4.0)	0.15
Relationship with Healthcare Provider (HCCQ)
	Baseline	21.0 (12.0-33.5)	25.0 (15.0-36.0)	0.05	-0.4 (11.2)	+4.7 (8.6)	0.051
	Follow-up	23.5 (14.2-29.8)	27.5 (19.5-38.2)	0.044	-0.4 (11.2)	+4.7 (8.6)	0.051
Competence (PCQ)
	Baseline	26.0 (22.8-28.0)	28.0 (27.0-28.0)	< 0.001	+0.2 (2.2)	+1.7 (4.2)	0.068
	Follow-up	28.0 (25.0-28.0)	28.0 (28.0-28.0)	0.002	+0.2 (2.2)	+1.7 (4.2)	0.068
Autonomous Motivation (TSRQ)
	Baseline	40.0 (36.0-42.0)	42.0 (38.5-42.0)	< 0.001	-1.1 (6.4)	+1.1 (6.8)	0.172
	Follow-up	40.0 (35.0-42.0)	42.0 (41.8-42.0)	0.003	-1.1 (6.4)	+1.1 (6.8)	0.172
Controlled Motivation (TSRQ)
	Baseline	16.5 (8.2-23.0)	13.0 (7.2-23.0)	0.444	-3.2 (7.9)	-0.8 (6.4)	0.187
	Follow-up	12.5 (6.0-22.0)	12.0 (6.8-20.0)	0.912	-3.2 (7.9)	-0.8 (6.4)	0.187
Amotivation (TSRQ)
	Baseline	4.0 (3.0-8.0)	4.5 (3.0-9.0)	0.988	-0.4 (3.9)	-0.1 (4.4)	0.759
	Follow-up	5.0 (3.0-8.0)	4.0 (3.0-7.8)	0.628	-0.4 (3.9)	-0.1 (4.4)	0.759
Quality of Life (CDQoL)
	Baseline	62.0 (49.0-77.0)	50.0 (37.0-59.5)	< 0.001	-1.1 (12.6)	-2.5 (12.4)	0.786
	Follow-up	50.0 (43.2-63.5)	45.5 (40.0-52.5)	0.252	-1.1 (12.6)	-2.5 (12.4)	0.786

Table: Table 1. Measures associated with GFD adherence. Data from the left half of the table (under "Non-Adherence" & "Adherence") represent score medians (Q1-Q3) at baseline and follow-up. Data on the right ("Worsened Adherence" & "Improved Adherence") represent change of score means (SD) from baseline to follow-up.
CDAT: Celiac Dietary Adherence Test; CSI: Celiac Symptom Index; PROMIS: PRO Measurement Information System; CD-QOL: Celiac Disease Quality of Life; TSRQ: Treatment Self-Regulation Questionnaire; PCS: Perceived Competence Scale; HCCQ: Health Care Climate Questionnaire

Disclosures:

Anna Lee indicated no relevant financial relationships.

Sonya Dasharathy indicated no relevant financial relationships.

Punya Chittajallu indicated no relevant financial relationships.

Janelle Smith indicated no relevant financial relationships.

Nancee Jaffe indicated no relevant financial relationships.

Lucia Chen indicated no relevant financial relationships.

Jeffrey Lackner indicated no relevant financial relationships.

Eric Esrailian indicated no relevant financial relationships.

Lin Chang indicated no relevant financial relationships.

Guy Weiss: EverlyHealth – Advisory Committee/Board Member.

Anna H. Lee, MD¹, Sonya Dasharathy, MD², Punya Chittajallu, MD², Janelle E. Smith, MS, RD³, Nancee Jaffe, MS, RD², Lucia Chen, MS¹, Jeffrey Lackner, PsyD⁴, Eric Esrailian, MD, MPH¹, Lin Chang, MD¹, Guy A. Weiss, MD⁵, 50, Longitudinal Analysis of Gluten-Free Dietary Adherence and Psychosocial Health in Gluten-Associated Disorders: The UCLA Celiac Collective, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.