Following Gluten Free Diet: Less Available, Higher Cost and Poor Nutritional Profile of Gluten-Free School Snacks

Background. Celiac disease has a high prevalence globally and to date the only effective treatment is a strict gluten-free diet for life. Diet compliance is difficult due to current unhealthy eating habits and increasing overweight/obesity, especially for school age children. Objectives. To assess availability, cost and nutritional adequacy of gluten-free school snacks. Methods. Five store categories (large, regular-size and wholesale supermarkets, health food stores and corner shops) were assessed in districts representing low, middle and high socioeconomic levels. Three categories of school snacks were surveyed: dairy products (milk boxes, yogurts), cereals (in bulk, cereal bars) and baked goods (various cookies). Portions and prices were standardized and the closest gluten-containing products were matched for comparison. Availability, cost and nutritional quality (total calories, total fat, carbohydrates and sodium) were then evaluated. Results. A total of 1562 products were assessed. Gluten-free products were less available, with significant differences among the socioeconomic levels for cereals and baked goods (P<0.05). Also, they were more expensive than gluten-containing products. Except for cereal calories and sodium in the upper socioeconomic level, less than one third of the products available met FAO/WHO recommendations. Products meeting all 4 characteristics (total calories, total fat, carbohydrates and sodium) analyzed were 7.8%, 7.3% and 7.3% in the upper, middle and low socioeconomic level, respectively. Conclusions. Gluten-free dairy products, cereals and baked snacks available as snacks for school-age celiac children are fewer, with less variety and more expensive than gluten containing counterparts; the majority of them not meeting current nutritional recommendations.