Assessment of the impact of adherence to gluten-free diet and other determinants on quality of life in children, adolescents and adults with celiac disease using specific instruments: A systematic review with meta-analysis

Objectives: Celiac disease (CD) is an autoimmune disease that affects many aspects of patients including their quality of life (QoL). The aim of this meta-analysis was to highlight the impact of gluten-free diet (GFD) adherence on QoL using specific instruments. Materials and methods: The included studies should meet to PRISMA guidelines. Thirty-nine studies using developed or adapted specific instruments were included in review, and 25 of them were included in meta-analysis. Results: In overall, the results showed a neutral QoL both in children and adolescents (47.81, 95% CI [40.50; 55.12]), and in adults (45.12, 95% CI [38.24; 52.00]). The QoL was low in subscales related to GFD such as "Diet" in CD-Dux, "Inadequate treatment" in CD-QoL and in "Dietary burden" in CD-AQ instruments. In children, the QoL was higher in patients adhering to GFD, with mean difference (MD) estimated at 8.24 (95% CI [5.11; 11.37]; P < 0.00001). All studies used CD-Dux as specific instrument and the results showed that the QoL was significantly lower in proxies than their children and adolescents (MD -5.60, 95% CI [-8.06; -3.15]; P < 0.00001). In adults, no significant difference was observed regarding the impact of GFD adherence on QoL (MD 3.68, 95% CI [-0.53; 7.88]; P = 0.09). Conclusion: Using specific instruments, this meta-analysis highlighted a reduced QoL in subscales related to GFD, and has been improved after GFD adherence.