ABSTRACT
Background: Food insecurity, defined as lack of consistent access to enough food for an active, healthy life was projected to affect 1 in 6 children in the United States in 2021. Market basket studies have consistently found that gluten-free (GF) foods are more expensive than their gluten-containing counterparts. We conducted an anonymous survey to determine the prevalence of food insecurity in households with children on a gluten-free diet (GFD) and how it can impact a child's adherence to a GFD. Methods: An anonymous electronic survey was distributed through celiac support groups, national celiac organization newsletters, and social media from March to May 2021. Survey items included demographic and medical information. Food insecurity risk before and during the COVID-19 pandemic was evaluated using the validated adapted Hunger Vital Signs Screener modified with “glutenfree food” to each screening question. Results: The 413 households with children on a GFD that completed the survey primarily self-identified as white (86%, 354). All 10 zip-code regions in the United States were represented. Most had a household income > $80000, resided in a mortgaged home, and were relatively well-educated. The most common reason for a GFD was celiac disease (CD) (92%, 378), and 72% (266) had been on a GFD for >2 years. All households noted a decrease in availability of GF foods during the pandemic (p<0.001). Pre-pandemic, 21% (86) of the households with at least one child following a GFD screened positive for food insecurity. When asked specifically about GF foods, 23% (94) of the households screened positive. Both food insecurity (25%, 104) and GF food insecurity (28%, 116) increased during the pandemic. Both before and during the COVID- 19 pandemic, 5% (19) of the households who were food secure screened positive for GF food insecurity. In one of ten households, individuals on a GFD ate gluten because there were no GF options available. Gluten ingestion due to unavailability of GF foods was higher in households who screened positive for food insecurity (aOR=5) or GF food insecurity (aOR=7). Gluten was eaten before and during the COVID-19 pandemic with a significant increase during the pandemic(p<0.001). Conclusions: Using a nationwide survey, we found that both overall and GF food insecurity have increased for households with children on a GFD. Rates of reported intentional gluten consumption because no GF options were available increased from 1 in 20 households to 1 in 10 households. Food insecurity increased the odds of a household member on a GFD eating gluten on purpose/intentionally. Food insecurity is an underrecognized risk to our celiac patients. Gastroenterologists should incorporate food insecurity screening into their practice for patients on a GFD, especially in the setting of celiac symptom exacerbation.(Figure Presented)Food Insecurity, Intentional Gluten Ingestion and Gluten-Free Food Availability (n=413) (a) Food and Gluten-Free Food Insecurity in Households with Children on a Gluten-Free Diet was measured by screening patients via the validated and adapted Hunger Vital Signs Screener. There was no significant difference in food insecurity before and during the pandemic. (b) Intentional Gluten Ingestion due to Unavailability of Gluten-Free Foods before and during pandemic was compared with test of proportions showing a significant difference (p value < 0.05) (c) Gluten-Free Food availability before the pandemic and (d) Gluten-Free Food availability during the pandemic showed decreasing availability of gluten free foods.