Effect of the COVID-19 pandemic on food insecurity in pediatric celiac disease

ABSTRACT

Background: The U.S. Department of Agriculture defines food insecurity as a lack of consistent access to enough food for an active, healthy life. Feeding America projects 13 million children (1 in 6) may experience food insecurity in 2021. Currently, a gluten-free diet is the only available treatment for celiac disease. Studies conducted around the world have shown consistently that gluten-free foods are more expensive than their gluten-containing counterparts. State and federal food assistance programs often do not account for the increased cost of gluten-free food. The purpose of our study was to determine the prevalence of food insecurity in families with a child diagnosed with celiac disease and whether or not food security has been affected by the coronavirus 2019(COVID-19) pandemic. Methods: An anonymous electronic survey was distributed through online community celiac support groups as well as national celiac organization newsletters. A total of three messages were posted in each online forum at approximately 2-week intervals. Basic demographic information and medical history was obtained. We evaluated food insecurity risk before COVID-19 and during the COVID-19 pandemic using the validated National Center for Health Statistics US Household Six-Item Short Form Food Security Survey Module. Results: A total of 118 responses were received. Responses were collected from all 10 zip-code regions in the United States. The median age of the gluten-free children was 12 years;34% (38) were male, 82% (97) lived in single child households and 70% (78) attended public school. In the households surveyed, 86% identified their race as white, 58% had salary >$100,000, 84% (92) mortgaged/owned their home and 84% (92) of the parents had at least a bachelor's degree. Most (91%) of the children were following a gluten-free diet for celiac disease, with 80% diagnosed via intestinal biopsy. The majority of participants (65%) had been on gluten-free diet for >2 years. Prior to the COVID-19 pandemic, 25% (29) of the participants screened positive for food insecurity and when asked specifically about gluten-free food access, 26% (31) of the participants screened positive. During the COVID-19 pandemic, access to gluten-free foods decreased (31% screened positive for food insecurity) even though the overall rate of food insecurity was stable (26%). 9% (10) of the children had eaten gluten because there were no gluten-free options available. During the COVID-19 pandemic, 35% (41) of the respondents reported that gluten-free foods in the area was limited (often going without things they need) or very poor (purchase most gluten-free foods online). Conclusions: Food insecurity affected nearly 1 in 3 surveyed families of children following a gluten-free diet during the COVID-19 pandemic. This is significantly higher than Feeding America's projections for food insecurity for 2021.There has also been decreased availability of gluten-free foods. During the COVID-19 pandemic, 1 in 10 children with celiac have eaten gluten because there were no gluten-free options available. Given these startling statistics, it is crucial that all gastroenterologists incorporate food insecurity screening into their practice for patients on gluten-free diets and be prepared to provide referrals to appropriate community resources.