Abstract:
Gluten-free diet is a lonely lifelong management for patients with celiac disease, which may affect their quality of life (QoL). This can be evaluated by generic or specific instruments. We used a specific-CD instrument to Moroccan-Arabic version (M-CD-DUX), and then apply it to evaluate the QoL of Moroccan celiac children and adult. CD-DUX instrument was translated and culturally adapted, and preliminarily evaluated on 15 children and their proxies. The reproducibility and internal consistency of M-CD-DUX were measured by intra-class coefficient (ICC) and Cronbach α tests respectively. The reliability of M-CD-DUX instrument showed a good internal consistency and reproducibility. The psychometric properties of M-CD-DUX were acceptable, and the instrument's Model fit was good [(Root Mean Square Error of Approximation = 0.062; χ2 = 603.08, p < 0.001]. M-CD-DUX was completed by 52 celiac children and their proxies. It showed a worse QoL for all items and subscales, and no difference was observed between the QoL of celiac children already under GFD and those recently diagnosed.
The same procedure was followed to assess Qol of Moroccan adults with CD. The Moroccan version of the CD-Q (M− CD− Q) was administered to 150 patients with CD, 112 of them completed it. The reproducibility and reliability of the M− CD− Q were studied by the intraclass coefficient (ICC) and Cronbach’s α, respectively. Parametric and nonparametric tests, confirmatory factor analysis, and Spearman correlation were used for the statistical analysis. No difficulties were found during the translation and cultural adaptation of the CD-Q. Cronbach’s α showed good internal consistency. The retest showed excellent reproducibility (ICC > 0.4). The psychometric properties of the M− CD− Q showed good acceptance, zero ceiling effect, and floor effect. The model fit was good [(root mean square error of approximation = 0.075 (<0.08) and χ2 = 509.04, p < 0.001]. The total scores showed a neutral QoL. This QoL was worse in the worries subscale, which is related to gluten free products. The GFD did not improve the QoL of the examined samples.
We did a meta-analyse about Assessment of the impact of adherence to gluten-free diet and other determinants on QoL, adolescents and adults with celiac disease using specific instruments: 25 studies were included. 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 = 0.0.
