British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life

Federico Biagia1 c1, Paola Ilaria Bianchia1, Alessandra Marchesea1, Lucia Trottaa1, Claudia Vattiatoa1, Davide Balduzzia1, Giovanna Bruscoa2, Alida Andreallia3, Fabio Cisaròa3, Marco Astegianoa3, Salvatore Pellegrinoa4, Giuseppe Magazzùa4, Catherine Klersya5 and Gino Roberto Corazzaa1

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

a2 Internal Medicine Unit, Ospedale Civile di Voghera, Voghera, Italy

a3 Department of Gastro-Hepatology, AOU San Giovanni Battista Molinette, University of Turin, Corso Bramante 88, 10126 Turin, Italy

a4 Regional Center for Celiac Disease, University of Messina, Messina, Italy

a5 Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy


A dietary interview performed by expert personnel is the best method to check whether patients with coeliac disease follow a strict gluten-free diet (GFD). We previously developed a score based on four fast and simple questions that can be administered even by non-expert personnel. The aim of the present study is to verify the reliability of our questionnaire in a new cohort of patients. The questionnaire has a five-level score. From March 2008 to January 2011, the questionnaire was administered to 141 coeliac patients on a GFD, who were undergoing re-evaluation. The score obtained was compared with persistence of both villous atrophy and endomysial antibodies (EMA). The rate of lower scores was higher among the patients with persistence of either villous atrophy (Fisher's exact, P < 0·001; test for trend, P < 0·001) or positive EMA (Fisher's exact, P = 0·001; test for trend, P = 0·018). Given that the coeliac patients have been well instructed on what a GFD means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a GFD.

(Received July 27 2011)

(Revised December 07 2011)

(Accepted December 07 2011)

(Online publication February 10 2012)

Key Words:

  • Coeliac disease;
  • Gliadin;
  • Endomysial antibodies;
  • Villous atrophy


c1 Corresponding author: Dr F. Biagi, fax +39 382 502618, email


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