British Journal of Nutrition

Full Papers

Human and Clinical Nutrition

A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease

Federico Biagia1 c1, Alida Andreallia1, Paola Ilaria Bianchia1, Alessandra Marchesea1, Catherine Klersya2 and Gino Roberto Corazzaa1

a1 Coeliac Centre/First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy

a2 Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy


A dietary interview performed by expert personnel is considered to be the most appropriate tool to check whether patients with coeliac disease follow a strict gluten-free diet. However, we currently have no straightforward and non-subjective method for performing such a dietary interview. We therefore developed a fast questionnaire based on four simple questions with a five-level score (0–IV). To verify whether our questionnaire is an efficient tool, we applied it to 168 coeliac patients (126 females and 42 males; mean age 42·4 (sd 12·9) years) on a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months). The score we obtained was compared with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. A comparison with survival of the patients was also performed. Patients were interviewed over the phone by non-expert personnel. The questionnaire was completed in less than 1 min. The lowest results were significantly more frequent among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Death risk was also significantly correlated with the lowest score results. We conclude that our questionnaire is a reliable and simple method of verifying compliance with a gluten-free diet.

(Received October 17 2008)

(Revised January 14 2009)

(Accepted February 09 2009)

(Online publication March 31 2009)


c1 Corresponding author: Dr F. Biagi, fax +39 0382 502618, email


Abbreviations: EMA, endomysial antibodies; GFD, gluten-free diet