P166 Does adherence to a gluten-free diet affect quality of life and sleep in patients with Non-Coeliac Gluten/Wheat Sensitivity?

Introduction

A gluten-free diet is the treatment for patients with coeliac disease, but the evidence for its use in Non-Coeliac Gluten/Wheat Sensitivity (NCGWS) is limited. We present the largest study assessing to what extent adherence to a gluten free diet in NCGWS affects quality of life and sleep quality.

Methods

Patients with NCGWS at a tertiary specialist centre were invited to complete a postal questionnaire between February and July 2018 that contained three validated assessment tools: the Coeliac Disease Adherence Test (CDAT), the Coeliac Symptom Index (CSI) and the Sleep Condition Indicator (SCI). The CDAT and CSI are validated tools to assess gluten-free diet adherence and symptom severity in coeliac disease respectively, the questionnaires were modified for patients with NCGWS. All patients had a diagnosis of coeliac disease excluded. The CDAT measures adherence to a gluten-free diet, with a score >13 indicating poor adherence. The CSI asks questions about symptoms and general health where a score <30 is associated with a high quality of life. The SCI assesses sleep quality; scores range from 0–32 with a higher score indicating better sleep. It appraises insomnia symptoms against Diagnostic and Statistical Manual of mental health disorders volume five (DSM-V) criteria. The results of these questionnaires were used to compare levels of adherence to a gluten-free diet with quality of life and sleep performance.

Results

In total, 125 patients with NCGWS (85% female, median age: 46 years, IQR: 35–59) took part. The median CDAT score was 17.0 (IQR: 13.25–20), which indicates poor adherence to a gluten-free diet. The median CSI score was 44 (IQR: 37–52). When using the suggested cut-offs for this tool, 40% of patient's scores are associated with a poor quality of life and only 13% would be associated with a high quality of life. The Median SCI score was 14 (IQR: 9–22) and the DSM-V threshold for insomnia was met by 42% of patients with NCGWS. There was a positive correlation between the CSI and CDAT scores (r=0.59, p<0.0001) and a negative correlation between SCI and CDAT scores (r=-0.37, p=0.0002).

Conclusion

Overall, adherence to a gluten-free diet is poor in patients with NCGWS. Poor adherence to a gluten-free diet correlated with a lower quality of life and worse sleep quality. Further work is needed to explain why adherence is poor, specialist follow up with dietetic interventions may be needed to improve it.