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What happens with the healthiness of the diet among Swedish adolescent  boys and girls when a gluten-free diet is required?
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0001-8944-2558
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.ORCID iD: 0000-0002-3731-6565
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives To explore how diagnosis of celiac disease (CD) in early adolescence affects overall food intake and healthiness of the diet in comparison with age- and sex matched controls and children with CD diagnosed in early childhood.

Methods This is a longitudinal dietary sub-study of a school-based CD-screening of 12-year-olds (ETICS - Exploring the Iceberg of Coeliacs in Sweden), a part of the PreventCD project. The dietary study was conducted in 2005-2008 and included the following groups resulting from the screening: I) screening-detected CD cases (n=80), II) previously diagnosed CD cases (n=28), and III) two samples of age- and sex matched non-CD children (admission, n=619; follow-up, n=447). All CD cases completed two food-frequency-and-amount-questionnaires (FFQ), covering the previous four weeks; one at admission and one at a follow-up 18-24 months later. The screening-detected CD cases completed the first FFQ before a gluten free diet was initiated. The non-CD children consisted of a cross-sectional sample at each time point, and thus only completed one FFQ each (i.e. either at admission or follow-up). The Goldberg cut-off method was used to validate reported energy intake. The food choices at admission and follow-up were compared among the three groups, and the healthiness of the diet evaluated using two Swedish dietary indexes.

Results and Conclusion Intakes of most food groups were similar at baseline. The adolescents diagnosed with CD did only minor changes in their overall food choices. Visible changes were reductions within food groups where gluten-free alternatives are not readily available, such as pastries and pizza. In contrast, total intake of bread and pasta did not change. All three groups scored fairly low on the dietary indexes at both time points, and there is an obvious need to improve the healthiness of the adolescent diet, whether CD is present or not.

National Category
Food Science Gastroenterology and Hepatology Pediatrics Other Social Sciences not elsewhere specified
Research subject
Food and Nutrition
URN: urn:nbn:se:umu:diva-43724OAI: diva2:415824
Available from: 2011-05-09 Created: 2011-05-09 Last updated: 2015-11-04Bibliographically approved
In thesis
1. Toward an understanding of the barriers to and facilitators of dietary change:
Open this publication in new window or tab >>Toward an understanding of the barriers to and facilitators of dietary change:
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Faktorer som underlättar respektive försvårar kostförändring :
Abstract [en]

Healthy dietary changes would be beneficial for society, as the economic burden of diet-related diseases is massive, and for the individual, who would reduce their risk of ill health. However, it is not easy to change dietary habits. Therefore, the aim of this thesis was to better understand dietary change, focusing on the barriers to and facilitators of healthy dietary change by i) examining changes in food choices when dietary change is imposed by a medical diagnosis, ii) examining experiences related to dietary change and its sustainability after participation in a study where healthy dietary changes were required, and iii) examining diet cost in relation to healthiness of the diet.

Methods Eighty children aged 13 who were diagnosed with celiac disease (CD) by a screening study reported their food intake in a food frequency questionnaire before and 1,5 years after commencing a gluten-free diet. Changes in food intake and the healthiness of the diet were examined, controlling for societal changes through the use of an age- and sex-matched control group. Diet healthiness was assessed using the National Food Administration’s (NFA) food index and the Diet Quality Index-Swedish Nutritional Recommendations. Qualitative interviews were conducted with 14 individuals who participated in an intervention study five years earlier where they had been randomly selected to adhere to a Mediterranean-like diet for three months. Analyses of the transcribed interviews focused on their experiences of barriers to and facilitators of dietary change and its sustainability. The costs related to healthy diets were examined by comparing consumer food prices with dietary intake data collected in two separate studies. The first study collected dietary intake data through a diet history interview with participants who had been randomized to either a Mediterranean-like diet or to continue their normal diet. The second study collected dietary intake data from 4-, 8-, and 11-year-old children by means of food diaries and was conducted by the NFA. Diet healthiness was assessed using the Healthy Eating Index 2005.

Results The screened CD group made relatively few changes to their diets. They decreased their intake of certain gluten-containing products, including pizza, chicken nuggets, fish sticks, and pastries. There were no changes in the healthiness of their diet. The narratives of the individuals changing their diets showed that social relationships were the main barrier to sustainability. Social relationships within the household were especially troublesome, and various coping strategies were required on an everyday basis. Dietary change also increased the burden of food work (e.g., planning, shopping, cooking), which was another major barrier to dietary change. Comparisons between consumer costs of healthy and less healthy diets showed that those consuming the healthier diets also had consumed more expensive diets.

Conclusion More barriers to healthy dietary changes were found than facilitators of these transitions. For instance, the impact of social relationships on sustainability of dietary change was found to be high, indicating the importance of participation of other household members when dietary changes are implemented. The higher cost of the healthier diets may be another barrier for healthy dietary changes, especially for those with limited resources. Even though it is possible to eat healthily at a lower cost, such a diet would likely require both cooking skills and time, thus making the task more difficult. However, the finding that children diagnosed with CD only made minor changes in their consumption of, for instance, bread and pasta, indicates that one way of increasing the healthiness of a diet is to substitute healthier alternatives within the same food group for less healthy food items.

Place, publisher, year, edition, pages
Umeå: Kostvetenskap, 2011. 89 p.
Dietary change, Healthy eating, Barriers, Facilitators, Dietary indexes, Diet cost, Food prices, Social relationships, Qualitative interviews, Mediterranean diet, Celiac disease, Children
National Category
Food Science
Research subject
Food and Nutrition
urn:nbn:se:umu:diva-43769 (URN)978-91-7459-189-7 (ISBN)
Public defence
2011-06-03, Hörsal C, Samhällsvetarhuset, Umeå Universitet, Umeå, 13:00 (Swedish)
Available from: 2011-05-13 Created: 2011-05-09 Last updated: 2011-05-11Bibliographically approved

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Rydén, PetraKautto, EthelIvarsson, AnneliOlsson, CeciliaNorström, FredrikHagfors, LindaHörnell, Agneta
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Department of Food and NutritionDepartment of Public Health and Clinical Medicine
Food ScienceGastroenterology and HepatologyPediatricsOther Social Sciences not elsewhere specified

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