Poor dietary choices can lead to inadequate nutritional balance in gluten-free diet (GFD).
Objective
Factors associated with better adherence to Mediterranean diet (MD) were determined in celiac pediatric population.
Methods
Eighty-one celiac adolescents were enrolled. Anthropometric, socioeconomic and clinical data were collected. Adherence to GFD and to MD, daily dietary intake, and energy expenditures were evaluated. Celiac disease-related quality of life (CD-QoL) and health-related quality of life (HRQoL) were assessed. Serum levels of vitamin D, ferritin, and C-reactive protein were analyzed. Correlations were determined between collected data, QoL, GFD, and MD adherence.
Results
Celiac adolescents showed neutral CD-QoL, moderate HRQoL, high level of sedentary behavior, and inadequate serum vitamin D levels. Low adherence to GFD and to MD was observed in 88% and 78% of celiac adolescents, respectively. Simple carbohydrates intake were high, whereas intakes of fibers, iron, calcium, and vitamins D and C were below recommendations. Positive correlations were found between MD adherence and consumption of fruits and vegetables (p < 0.001), and polyunsaturated fatty acids (p = 0.01). Furthermore, GFD adherence was highly correlated with mealtime conviviality (p < 0.001), CD-QoL with gluten-free product palatability (p = 0.001), and HRQoL with gender (p < 0.001). MD adherence was associated with strict GFD adherence (p = 0.001), sufficient budget for gluten-free products (p = 0.007), and not skipping meals (p = 0.016).
Conclusion
Improving MD adherence in celiac adolescents is essential. Strict GFD, favorable socioeconomic status, and regular meal patterns are associated with better MD adherence. Additionally, mealtime conviviality, higher maternal education, and effective GFD management indirectly support MD adherence by enhancing both GFD compliance and QoL.
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