Changes in gluten-free diet adherence and growth parameters among children with celiac disease during the COVID-19 pandemic

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Erkol Yılmaz Y., Tuna Kırsaçlıoğlu C., Ensari A., Kuloğlu Z.

FRONTIERS IN PEDIATRICS, cilt.14, ss.1-10, 2026 (SCI-Expanded, Scopus)

Özet

Abstract

Objectives: 

Strict exclusion of gluten is the cornerstone of celiac disease (CD) management; nevertheless, maintaining dietary adherence remains challenging. The COVID-19 pandemic may have influenced dietary adherence in children with CD. This study aimed to investigate the association between the COVID-19 pandemic and gluten-free diet (GFD) adherence and anthropometric measurements.

Methods: 

This retrospective longitudinal cohort study with a cross-sectional survey component included 81 pediatric patients with CD (67.9% female; mean age 14.9 ± 3.4 years) who had been following a GFD for at least one year before the pandemic. Demographic, clinical, laboratory, and anthropometric data from the pre-pandemic, restriction, and post-pandemic periods were obtained from medical records. Dietary adherence was assessed via a structured telephone questionnaire. Participants reporting either complete avoidance of gluten or fewer than six inadvertent gluten exposures annually were categorized as self-reported adherent. Serological adherence was defined by a negative tTG-IgA result.

Results: 

At the beginning of the pandemic in March 2020, the mean duration of GFD was 3.9 ± 2.4 years. At the time of the survey, self-reported adherence was 67.9% (55/81), whereas serological adherence was 77.1% (54/70). During the pandemic, 49.4% of participants reported no change in dietary adherence, 33.3% reported increased adherence, and 17.3% reported decreased adherence. Serological adherence differed significantly across the three longitudinal assessment periods (Cochran's Q = 31.818, p < 0.001). Compared with the pre-pandemic period (51.9%, 42/81), serological adherence was significantly higher during both the restriction period (82.7%, 67/81) and the post-pandemic period (76.5%, 62/81) (McNemar p < 0.001 for both comparisons), whereas no significant difference was observed between the restriction and post-pandemic periods (McNemar p = 0.227). Serological adherence was associated with home-cooking and selected family and socioeconomic factors. Most participants (87.7%) reported difficulty accessing gluten-free products, mainly due to high cost and limited variety. No significant differences were observed in anthropometric measurements across the study periods.

Conclusion: 


Serological adherence was significantly higher during both the COVID-19 restriction and post-pandemic periods than during the pre-pandemic period, while no significant changes in anthropometric measurements were observed.