The gluten-free diet: access and economic aspects and impact on lifestyle

Figures & data

Table 1 Availability rates of gluten-free versions (total versions=16) and different GFPs (total number= 100) in five cities from Northwestern Mexico

Food	% of availability/100 (number of different versions)
	Tijuana	Mexicali	La Paz	Hermosillo	Culiacan
Cookies	0.71 (5)	0.71 (5)	0.28 (2)	0.42 (3)	0.28 (2)
Crackers	0.75 (6)	0.37 (3)	0	0.37 (3)	0.37 (3)
Loaves	0.66 (2)	0.33 (1)	0	0.33 (1)	0.66 (2)
Pastas	0.54 (6)	0.45 (5)	0.27 (3)	0.45 (5)	0.54 (6)
Noodles	1.0 (3)	0.33 (1)	0	0.66 (2)	0.66 (1)
Lasagna	0.66 (2)	0	0	0	0.66 (2)
Maize cereals	0.66 (2)	0.33 (1)	0	0.66 (2)	0.66 (2)
Rice cereals	0.6 (3)	0.4 (2)	0.2 (1)	0.4 (2)	0
Breading mixes	0.5 (1)	0	0	0	1.0 (2)
Mixes for cakes and hot cakes	0.55 (5)	0.11 (1)	0.11 (1)	0.33 (3)	0.55 (5)
Multipurpose mixes	0.55 (5)	0.11 (1)	0.22 (2)	0.22 (2)	0.44 (4)
Mixes for pizza crust	0.5 (1)	0	0	0	0.5 (1)
Mixes for cookies	0.33 (1)	0.33 (1)	0.33 (1)	0	1.0 (3)
Nachos and chips	0.33 (3)	0.22 (2)	0.22 (2)	0.44 (4)	0.55 (5)
Cereal bars	0.22 (4)	0.22 (4)	0.33 (6)	0.27 (5)	0.33 (6)
Baby porridges	0.20 (1)	0.20 (1)	0	0.20 (1)	0.80 (4)
Availability (gluten-free versions)^Table Footnotea	1.0 (16)	0.81 (13)	0.5 (8)	0.75 (12)	0.94 (15)
Availability (different GFPs)^Table Footnotea	0.50 (50)	0.28 (28)	0.18 (18)	0.33 (33)	0.48 (48)

Note:

a Average availability is based on supermarkets and specialized stores visited in each city.

Abbreviation: GFPs, gluten-free products.

Table 2 Availability rates of gluten-free versions (total versions=16) and different GFPs (total number=100) per store category

Food	% of availability/100 (number of different versions)
	Supermarkets	Health food stores	Overall
Cookies	1.0 (7)	0	1.0 (7)
Crackers	1.0 (8)	0	1.0 (8)
Loaves	0.66 (2)	0.33 (1)	1.0 (3)
Pastas	0.72 (8)	0.54 (6)	1.0 (11)
Noodles	1.0 (3)	0.66 (2)	1.0 (3)
Lasagna	0.33 (1)	0.66 (2)	1.0 (3)
Maize cereals	1.0 (3)	0.33 (1)	1.0 (3)
Rice cereals	1.0 (5)	0	1.0 (5)
Breading mixes	0	1.0 (2)	1.0 (2)
Mixes for cakes and hot cakes	0.44 (4)	0.66 (6)	1.0 (9)
Multipurpose mixes	0.77 (7)	0.33 (3)	1.0 (9)
Mixes for pizza crust	0.5 (1)	0.5 (1)	1.0 (2)
Mixes for cookies	0	1.0 (3)	1.0 (3)
Nachos and chips	0.55 (5)	0.44 (4)	1.0 (9)
Cereal bars	0.66 (12)	0.38 (7)	1.0 (18)
Baby porridges	0.2 (1)	0.8 (4)	1.0 (5)
Availability (gluten-free versions)^Table Footnotea	0.87 (14)	0.81 (13)	1.0 (16)
Availability (different GFPs)^Table Footnotea	0.67 (67)	0.42 (42)	1.0 (100)

Note:

a Average availability is based on 16 supermarkets and 10 health food stores.

Abbreviation: GFPs, gluten-free products.

Figure 1 Availability rates per store.

Notes: (A) Availability of gluten-free versions (n=16 [100%]). (B) Availability of different GFPs (n=100 [100%]). The x-axes show individual results for each supermarket and health food store surveyed. ẋ represents either all supermarkets (n=16) or all specialized stores (n=10).
Abbreviation: GFPs, gluten-free products.

Table 3 Cost comparison of gluten-free versions vs gluten-containing products

Food	Mean^Table Footnotea (SD) [n]^Table Footnoteb		P-value
	GFP	Gluten-containing
Cookies	51.8 (30.8) [10]	11.0 (8.2) [16]	0.008
Crackers	39.8 (21.4) [8]	7.6 (4.4) [16]	0.004
Loaves	23.0 (7.3) [5]	9.0 (8.0) [16]	0.029
Pastas	26.5 (15.3) [13]	3.5 (1.9) [16]	0.005
Noodles	31.5 (13.7) [5]	11.8 (5.5) [16]	0.015
Lasagna	35.2 (14.3) [4]	9.2 (4.6) [16]	0.028
Maize cereals	33.5 (10.3) [6]	11.0 (4.0) [16]	0.002
Rice cereals	21.0 (4.8) [6]		0.004
Breading mixes	45.0 (22.6) [2]	7.3 (2.8) [16]	ND
Batter mixes for cakes and hot cakes	26.1 (11.8) [16]	7.1 (4.4) [16]	0.010
Multipurpose mixes	28.3 (19.7) [9]	2.6 (2.7) [16]	0.005
Batter mix for pizza crust	19.5 (2.1) [2]	7.0 (0.0) [12]	ND
Batter mix for cookies	20.5 (10.9) [4]	8.2 (0.9) [12]	0.028
Nachos and chips	58.5 (50.9) [13]	14.6 (10.6) [16]	0.179
Cereal bars	57.0 (42.7) [13]	16.5 (3.8) [16]	0.126
Baby porridges	37.8 (25.6) [5]	7.9 (0.6) [16]	0.002

Notes: The cost (Mexican pesos) of 100 g of each food product was used for comparisons.

a Average of branded gluten-free, cheapest gluten-free, or branded glutencontaining, cheapest gluten-containing.

b Number of stores that contributed cost data. Bold values indicate statistically significant differences.

Abbreviations: GFP, gluten-free product; ND; not determined due to insufficient sample.

Table 4 GFD survey results stratified by concept

Concept	Affirmation/question	Options	Percentage (n)
Health improvement	Did your health improve after the introduction of the GFD?	Improved a lot	86.1 (31)
		Moderate improvement	13.8 (5)
		Little improvement	0
		No improvement	0
Difficulty following a GFD	Is the GFD difficult to follow?	Very difficult	75 (27)
		Moderately difficult	16.6 (6)
		Not difficult	8.3 (3)
Information sources	Who instruct you about the GFD? (you can choose more than one option)	I look for information on the Internet	88.8 (32)
		I consult books and other sources	30.5 (11)
		Physician/gastroenterologist	61.1 (22)
		Dietitian	30.5 (11)
	If you are seeing a physician/gastroenterologist or dietitian, how do you rate the information received?	Very helpful	33.3 (11)
		Moderately helpful	12.1 (4)
		Unhelpful	54.5 (18)
Reasons that influence poor dietary compliance (rate the following affirmations)	It is difficult to find GFPs in local stores	Strongly influences	83.3 (30)
		Moderately influences	16.6 (6)
		No influence	0
	The cost of commercially available GFPs limits their purchase	Strongly influences	100 (36)
		Moderately influences	0
		No influence	0
	Unsatisfied with the taste and texture of GFPs	Strongly influences	0
		Moderately influences	52.7 (19)
		No influence	47.2 (17)
Lifestyle	Are you affected by the limitations in your	Yes, I am	47.2 (17)
	meals with your family?	No, I am not	52.7 (19)
	Do you avoid social activities?	Yes, I do	88.8 (32)
		No, I do not	11 (4)
	Do you have difficulty to travel?	Yes, I do	83.3 (30)
		No, I do not	16.6 (6)
	Are you limited in your work/school	Yes, I am	33.3 (14)
	activities because of the GFD?	No, I am not	66.6 (24)
	Are you afraid of dining out because of	Yes	97.2 (35)
	gluten contamination of food?	No	2.7 (1)

Abbreviations: GFD, gluten-free diet; GFPs, gluten-free products.