Quality of Life in Children and Adolescents with Celiac Disease in the Russian Federation: Results of the Cross-Sectional Multicenter Study

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Introduction. Assessing the quality of life of patients with various chronic diseases, including celiac disease, is an important component of scientific research, determining the rationale and effectiveness of treatment and rehabilitation strategies. Few studies have examined the quality of life of children with celiac disease on a gluten-free diet. Furthermore, all of these studies utilized a variety of questionnaires. Aim: to study the quality of life of children and adolescents with celiac disease on a gluten-free diet using a validated Russian-language version of the CD-QOL questionnaire. Materials and methods. A cross-sectional study surveyed 599 children and adolescents with celiac disease (aged 2–22 years) using a validated Russian-language version of the CD-QOL questionnaire; the impact of diet on social functioning was also assessed. Comparisons were made using Student’s t -test (Welch’s test was used if homogeneity of variances was not met). For age groups, one-way analysis of variance (ANOVA) was used, with a preliminary check for homogeneity of variances using Levene’s test; in case of homogeneity, Tukey’s post-hoc test was performed. In cases of deviations from normality, the nonparametric Mann — Whitney test was used to compare independent groups. Multiple linear regression was used to assess the influence of factors on indicator levels; associations between variables were additionally assessed using the Pearson or Spearman correlation. The significance level was p < 0.05. Results. The mean subscale scores for 599 respondents were: “social-emotional limitations” — 3.39 (SD = 0.96),“anxiety/fear for health” — 3.16 (SD = 1.07). A moderately strong positive correlation was found between the subscales ( r = 0.649; p < 0.001). No gender differences were found ( p = 0.956 and p = 0.970 for both subscales). In the analysis by age groups, a statistical trend was observed for the “limitations” component (ANOVA: F (3,590) = 2.63; p = 0.053). For the anxiety component, with confirmed homogeneity of variances using Levene’s test, significant between-group differences were revealed (ANOVA: F (3,590) = 8.84; p < 0.001). Tukey’s post-hoc comparisons revealed higher values in younger groups compared to adolescents and adults. Linear regression showed that anxiety was most strongly associated with the severity of socioemotional limitations (β = 0.636; p < 0.001) with an independent negative effect of age (β ≈ –0.24; p < 0.01). The model explained 44.4 % of the variance ( R 2 = 0.444); VIF < 1.1. Psychometric analysis confirmed the two-factor structure with high internal consistency of the subscales (α = 0.904 and α = 0.874). Conclusions. The quality of life of children and adolescents with celiac disease on a gluten-free diet is characterized by moderate "restriction burden" and associated anxiety. Anxiety is higher in younger age groups; no gender differences were found. The priority of medical and social support is to reduce daily limitations through organizational and environmental measures (in educational and leisure contexts, when eating out), supplemented by psychoeducational support for families, especially in younger age groups. According to the study, such measures are associated with reduced anxiety and improved daily functioning.

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