BACKGROUND AND AIMS The only treatment for celiac disease is strict adherence to a gluten-free diet (GFD). We performed a systematic review to investigate the rate of adherence to a GFD in children with celiac disease, risk factors that affect adherence, and outcomes of non-adherence. METHODS We searched PubMed, Cochrane Library, EBSCO, and Scopus for studies through January 2019. We included observational studies of ≥50 children diagnosed with celiac disease and recommended for placement on a GFD. We collected data on adherence assessment (self-report, serology tests, structured dietary interview, biopsies, or assays for gluten immunogenic peptides), risk factors, and outcomes related to adherence. Findings were presented with medians, range, and a narrative synthesis. RESULTS We identified 703 studies; of these, 167 were eligible for full-text assessment and 49 were included in the final analysis, comprising 7850 children. Rates of adherence to a GFD ranged from 23% to 98%. Comparable rates (median rates of adherence, 75%-87%) were found irrespective of how assessments were performed. Adolescents were at risk of non-adherence and children whose parents had good knowledge about celiac disease adhered more strictly. Non-adherence associated with patient growth, symptoms, and quality of life. CONCLUSION In a systematic review of 49 studies of children with celiac disease, we found substantial variation in adherence to a GFD among patients. Rate of adherence was not associated with method of adherence measurement, so all methods appear to be useful, with lack of consensus on the ideal metric. Studies are needed to determine the best method to ensure adherence and effects on long-term health.

中文翻译：

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儿科乳糜泻患者不依从性的比率、危险因素和结果：系统评价。

背景和目的 乳糜泻的唯一治疗方法是严格遵守无麸质饮食 (GFD)。我们进行了一项系统评价，以调查乳糜泻儿童对 GFD 的依从率、影响依从性的风险因素以及不依从性的结果。方法 我们在 PubMed、Cochrane 图书馆、EBSCO 和 Scopus 中搜索了截至 2019 年 1 月的研究。我们纳入了对 50 名以上被诊断患有乳糜泻并建议安置在 GFD 上的儿童的观察性研究。我们收集了关于依从性评估（自我报告、血清学测试、结构化饮食访谈、活检或麸质免疫原性肽检测）、风险因素和与依从性相关的结果的数据。结果以中位数、范围和叙述性综合呈现。结果 我们确定了 703 项研究；其中，167人符合全文评估条件，49人纳入最终分析，包括7850名儿童。遵守 GFD 的比率从 23% 到 98% 不等。无论评估是如何进行的，都发现了可比的比率（中位依从率，75%-87%）。青少年有不依从的风险，而父母对乳糜泻有良好了解的儿童则更严格地依从。与患者成长、症状和生活质量相关的不依从性。结论 在对 49 项乳糜泻儿童研究的系统评价中，我们发现患者对 GFD 的依从性存在很大差异。依从率与依从性测量方法无关，因此所有方法似乎都是有用的，但对理想指标缺乏共识。