Systematic review: Adherence to a gluten-free diet in adult patients with coeliac disease.Hall NJ, Rubin G, Charnock A. Aliment Pharmacol Ther. 2009 May 26. [Epub ahead of print] ABSTRACT Background: Coeliac disease (CD) is increasingly diagnosed in adult patients who present with atypical symptoms or who are asymptomatic and detected by case screening. Its treatment, a gluten-free diet (GFD), can have a considerable impact on daily living. Understanding the factors associated with non-adherence is important in terms of supporting patients with their condition. Aim: To investigate factors associated with adherence to a GFD in adults with CD. Methods: A literature search of multiple electronic databases using a pre-determined search string for literature between 1980 and November 2007 identified a possible 611 hits. After checking for relevance 38 studies were included in this review. Results: Rates for strict adherence range from 42-91% depending on definition and method of assessment, and are lowest among ethnic minorities and those diagnosed in childhood. Adherence is most strongly associated with cognitive, emotional and socio-cultural influences, membership of an advocacy group and regular dietetic follow-up. Screen and symptom-detected coeliac patients do not differ in their adherence to a GFD. Conclusions: The existing evidence for factors associated with non-adherence to a GFD is of variable quality.. Further and more rigorous research is needed to characterise those individuals most likely to be non-adherent in order to better assist them with their treatment.