Previous Article in Journal
Clinically Based Cetuximab Re-Challenge in Patients with RAS Wild-Type Metastatic Colorectal Cancer and Retrospective Analysis of Liquid Biopsies—Preliminary Data
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Gastrointestinal Disorders
Volume 7
Issue 3
10.3390/gidisord7030043
gastrointestdisord-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Mediterranean Diet and Health-Related Quality of Life in Patients with Celiac Disease

by
Emmanuel Psylinakis
,
Nikolaos Thalassinos
,
Aikaterini-Maria Dafouli
,
Maria Kanaki
,
Alexios Manidis
,
Anastasia G. Markaki
and
Aspasia Spyridaki
*
Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos Area, 72300 Sitia, Greece
*
Author to whom correspondence should be addressed.
Gastrointest. Disord. 2025, 7(3), 43; https://doi.org/10.3390/gidisord7030043
Submission received: 13 May 2025 / Revised: 24 June 2025 / Accepted: 25 June 2025 / Published: 27 June 2025
Browse Figures
Versions Notes

Abstract

Background/Objectives: Celiac disease (CD) is an immune-mediated condition triggered by gluten ingestion in genetically predisposed individuals, requiring lifelong adherence to a strict gluten-free diet (GFD). Despite dietary compliance, many patients with CD experience impaired health-related quality of life (HRQoL). Emerging evidence suggests that dietary quality may influence HRQoL. Although the Mediterranean diet (MD) is linked to multiple health benefits, its role in CD management remains underexplored. This study aimed to investigate the relationship between MD adherence and HRQoL in adults with CD. Methods: In this cross-sectional study, adherence to the MD was assessed using the MedDiet Score. HRQoL was evaluated using the Short Form-12 (SF-12), measuring the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Results: The study enrolled 100 individuals with CD and 100 age- and sex-matched healthy controls. The mean MedDiet Score (MDS) was 30.4 ± 3.9 for patients and 30.7 ± 5.0 for controls (p = 0.709), with moderate adherence in most participants. The patients had significantly lower PCS scores (43.80 ± 4.99) compared to controls (45.45 ± 4.76; p = 0.015), while the MCS scores did not differ significantly (42.12 ± 8.05 vs. 42.79 ± 6.56; p = 0.738). In individuals with CD, the MedDiet Score was positively correlated with MCS12 (ρ = 0.302, p = 0.002), but not with PCS12 (ρ = 0.059, p = 0.562). Conclusions: Adherence to the MD is associated with better mental health outcomes in individuals with CD. Promoting a Mediterranean-style GFD may offer a holistic approach to enhancing well-being in this population.

1. Introduction

Celiac disease (CD) is a chronic immune-mediated disorder induced by gluten ingestion [1]. In genetically predisposed individuals, gliadin, the alcohol-soluble fraction of gluten, is responsible for triggering an inflammatory immune response that primarily affects the small intestine, leading to villous atrophy, malabsorption, and various clinical manifestations [2]. Several studies have demonstrated that gliadin may stimulate the release of zonulin, a protein that modulates intestinal tight junctions and increases gut permeability, allowing harmful antigens to cross the epithelial barrier and contribute to intestinal inflammation [3,4].
The classical symptoms of CD include diarrhea, weight loss, and abdominal pain, but many patients present with non-gastrointestinal symptoms, such as anemia, osteoporosis, neurological disorders, infertility, and even psychiatric conditions like depression and anxiety [5]. Furthermore, CD is frequently associated with autoimmune disorders, including type 1 diabetes mellitus, autoimmune thyroid diseases, rheumatoid arthritis, systemic lupus erythematosus, and dermatitis herpetiformis.
The only effective treatment for CD is strict, lifelong adherence to a gluten-free diet (GFD) [6]. While a GFD promotes intestinal healing and helps alleviate symptoms in most cases, it can be socially restrictive, nutritionally imbalanced, and difficult to maintain. Despite dietary adherence, many individuals with CD continue to experience persistent symptoms, nutritional deficiencies, and a greater likelihood of metabolic complications [7,8,9]. Moreover, recent research suggests that a GFD may negatively impact gut microbiota diversity and composition, contributing to dysbiosis [10,11]. These health issues, along with dietary restrictions and social limitations, can significantly impact overall well-being and lead to compromised health-related quality of life (HRQoL) [12,13].
The Mediterranean diet (MD) is a well-established dietary pattern characterized by a high consumption of fruits, vegetables, and whole grains, including naturally gluten-free options such as rice, quinoa, corn, buckwheat, and amaranth, olive oil, nuts, and fish, with a moderate intake of dairy and limited red meat consumption, which can easily be rendered gluten-free [14,15]. In addition to its anti-inflammatory and cardiometabolic benefits, the MD has been increasingly recognized for its positive effects on gut microbiota composition and function [16,17]. These microbiota-mediated mechanisms may have particular significance for gastrointestinal health in conditions such as CD, where maintaining microbial balance is emerging as a key component of long-term management [18]. However, despite its known advantages, the potential role of the MD in CD remains relatively unexplored [19,20].
In view of the above, the present study aimed to examine the relationship between adherence to the MD and HRQoL in adults with CD, against a matched group of healthy individuals.

2. Results

2.1. Participant Characteristics

The study recruited 100 patients with CD (85 women and 15 men) aged 38.7 ± 10.6 years, along with 100 age- and sex-matched healthy controls, aged 38.9 ± 10.4 years, matched within ±2 years. The mean age at CD diagnosis was 30.6 ± 13.1 years, and the mean duration on a gluten-free diet (GFD) was 6.6 ± 6.9 years. Among patients with CD, 80 (80%) were diagnosed via intestinal biopsy, while 20 (20%) were diagnosed through serologic testing.
Table 1 presents the demographic profile of the patients and controls. The majority of participants were employed, working in the public and private sectors, as well as in self-employment and highly educated (university degree or higher).

2.2. Mediterranean Diet and Health-Related Quality of Life Scores

The scores concerning MD adherence and HRQoL are presented in Table 2. MedDiet Score was 30.4 ± 3.9 for patients and 30.7 ± 5.0 for the control group, with no statistically significant difference between the two groups. Regarding HRQoL, the mean PCS score was 43.8 ± 5.0 in patients and 45.5 ± 4.8 in controls. A statistically significant difference was observed in the PCS score between the patient and control groups, with patients reporting lower scores (Figure 1). The mean MCS score was 42.1 ± 8.0 in individuals with CD and 42.8 ± 6.6 in controls, with no statistically significant difference found between the two groups.

2.3. Adherence Levels to the Mediterranean Diet

Regarding adherence to the MD in the control group, 15% demonstrated high adherence, while 84% showed moderate adherence, and 1% were categorized as having low adherence (Table 3). In the CD group, the majority, 91%, exhibited moderate adherence and 8% demonstrated high adherence to the Mediterranean diet. Only 1% showed low adherence.

2.4. Correlation Analysis

The statistical analysis indicated a positive association of MD adherence with mental health (MCS) in both patients (r = 0.302, p = 0.002) and controls (r = 0.330, p = 0.001), as illustrated in Figure 2. In contrast, no significant associations were found between the MedDiet Score and PCS in either group (patients: r = 0.059, p = 0.562; controls: r = −0.097, p = 0.339).

3. Discussion

This study is the first to examine the association between MD adherence and HRQoL in individuals with CD, revealing a novel relationship with better quality of life.
Most participants, both patients and controls, exhibited moderate adherence to the Mediterranean diet, with no statistically significant difference in MedDiet Score between groups. This aligns with findings by Peresztegi et al. [20], who also reported suboptimal but comparable adherence in patients with CD and controls. In contrast, two Italian studies reported significantly lower MD adherence in patients with CD compared to healthy individuals, characterized by a higher intake of red and processed meats, potatoes, dairy products, and a lower intake of vegetables and fish [21,22].
Given that this study was conducted in the Mediterranean region, the MD is traditionally part of the local dietary culture [20]. However, declining adherence to the MD has been reported not only in individuals with chronic diseases but also among the general population in Mediterranean countries. This trend likely reflects the growing influence of Western dietary patterns, which are increasingly displacing traditional healthy eating habits, even in Mediterranean regions [15,22].
Patients with CD in our study reported lower HRQoL in both physical and mental domains compared to the control group, although only the difference in physical health reached statistical significance. These findings align with previous studies indicating that individuals with CD have lower HRQoL than the general population [23,24].
This study revealed a significant correlation between greater MD adherence and higher mental health scores in both the CD and control groups. It is possible that individuals who are highly motivated and possess a health-oriented mindset may be the ones with better mental health and also those more likely to adopt healthier eating habits [25,26]. This predisposition could partially account for the association observed in our study. While enhanced psychological well-being may encourage healthier dietary patterns and consequently greater adherence, this relationship appears to be bidirectional, with existing literature strongly supporting the influence of greater adherence to the MD on improved mental health.
A recent systematic review of 28 studies, including both general and clinical populations, highlighted the beneficial impact of the MD on HRQoL [27]. Our results suggest that this positive impact extends to individuals with CD as well, further supporting the significance of dietary quality in promoting overall well-being within clinical populations.
In accordance with our findings, a previous study on Greek patients with CD reported that higher adherence to the MD was significantly associated with lower levels of several psychopathological dimensions, including obsessive–compulsive symptoms, depression, hostility, phobic anxiety, and psychoticism, specifically among female patients [13]. In contrast, no significant associations were observed among male participants, potentially reflecting their limited representation in that study. Notably, the majority of patients were classified as non-adherent, and the broad distribution of adherence scores allowed for stratification into low and high adherence groups, revealing a significant link difference in psychopathological symptom severity among female patients. Our findings corroborate the observed link between higher MD adherence and lower psychological distress, and extend this association across genders.
Accumulating evidence suggests that adherence to the MD is associated with improved mental health outcomes. The MD supplies a variety of beneficial compounds, including omega-3 fatty acids and polyphenolic antioxidants, which may mitigate neuroinflammation and oxidative stress [28]. In addition, it provides essential nutrients, such as B-complex vitamins and magnesium, which play key roles in neurotransmitter synthesis and regulation [29,30]. Moreover, emerging research indicates that the MD may exert its beneficial effects by positively modulating the diversity, composition, and functional activity of the gut microbiota [31]. The intestinal microbiota constitutes a fundamental component of the gut–brain axis and may influence brain function through the production of hormones, neurotransmitters, and immune-related signaling molecules [32,33,34]. The complex interplay of the gut–brain axis, which includes interactions between the gastrointestinal tract, microbiota, and central nervous system, is increasingly implicated in both gastrointestinal and neuropsychiatric disorders [35,36]. This may be particularly relevant in CD, which, although centered on autoimmune damage in the small intestine, is now recognized as a systemic condition with neurological and psychiatric manifestations [4,36].
Although the present study did not directly assess gut microbiota composition, dysbiosis has been well-documented in individuals with celiac disease, including those adhering to a GFD [10,11]. The persistence of altered microbial communities in patients with CD may contribute to systemic inflammation and impaired gut–brain communication, both of which have been implicated in psychological distress [32,36]. Given the gut-modulatory role of the MD, it is plausible that the improved mental health outcomes observed in this study may, in part, be mediated through microbiota-related mechanisms. This interpretation aligns with the growing recognition of the gut–brain axis as a central interface linking diet, immune function, and psychological well-being, particularly in individuals with gastrointestinal disorders [10,37]. In this context, incorporating the MD may offer a more holistic approach to CD management by providing additional benefits beyond gluten avoidance.
This study presents specific limitations that should be considered. First, as it is based on an online survey, the study is susceptible to selection bias and depends solely on self-reported data. Additionally, our analyses were constrained by the cross-sectional nature of the data. Finally, the clustering of adherence scores around the moderate range in both the CD and control groups may have restricted the ability to detect the full impact of MD adherence on HRQoL outcomes. Additional studies, preferably using advanced analytical tools such as Random Forest and SHAP analysis, could be useful in further exploring the interplay between the MD, HRQoL, and potential underlying factors such as motivation and a health-oriented mindset. Longitudinal research is warranted to fully elucidate the role of the MD on overall health and well-being in individuals with CD. Nevertheless, given the novel association identified in this study linking the MD with better mental health, encouraging a Mediterranean-style gluten-free diet may serve as an effective nutritional strategy to enhance quality of life in this patient population.

4. Materials and Methods

4.1. Study Design

This cross-sectional study included 100 patients with CD and 100 age- and sex-matched healthy controls (±2 years), aged 18–60 years.

4.2. Ethical Considerations

The research protocol was approved by the Institutional Review Board of the Hellenic Mediterranean University (Approval No. 30922, 2024), and all procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki.

4.3. Survey Description and Distribution

Data was collected through an online questionnaire, which included demographic characteristics, CD-specific questions, gluten-free diet adherence (only for the CD group), MedDiet Score and HRQoL. The survey was disseminated online via celiac organizations, support groups, and healthcare centers for the patient group, and through general community networks for the control group. The survey was accessible via Google Forms between 8 November 2024 and 20 February 2025. It included an introduction outlining the study’s aim, inclusion criteria, and key information regarding eligibility, voluntary participation, and data confidentiality. Participants were required to provide electronic informed consent, which was mandatory before they could access the questionnaire.

4.4. Eligibility Criteria

Participants had to meet the following inclusion criteria:
(a)
Adults aged ≥ 18 years.
(b)
CD diagnosis made at least one year prior to participation (for the CD group) and no history of CD (for the control group).
(c)
On a strict GFD, reporting never consuming gluten or consuming gluten fewer than three times per year (CD group only).
The exclusion criteria were the presence of serious illnesses, including chronic renal or pulmonary conditions, malignancies, cardiovascular disease, and Alzheimer’s disease.

4.5. Mediterranean Diet Score

The Mediterranean Diet Score (MedDiet Score) was used to evaluate adherence to the MD. The MedDiet Score is a validated tool widely used in dietary research to assess dietary intake patterns based on the frequency of the consumption of key diet food groups associated with the MD. Scores range from 0 to 55, with 0–20 indicating low, 21–35 moderate, and 36–55 high adherence [38].

4.6. Health-Related Quality of Life

The Short Form-12 (SF-12) v.1, health survey was used to assess HRQoL. SF-12 measures two main components: PCS and MCS. Higher scores indicate better HRQoL across both dimensions [39,40].

4.7. Statistical Analysis

A statistical analysis was performed using SPSS version 29. Descriptive statistics for nominal and ordinal variables were presented as frequencies and percentages, while continuous data were expressed as means with standard deviations. Comparisons between categorical variables were conducted using the chi-square test. Group differences in the physical health, mental health, and MedDiet Scores between patients and controls were analyzed using an independent samples t-test. Correlations were evaluated with Pearson or Spearman tests, based on the distribution characteristics of the variables. The level of significance was p < 0.05.

5. Conclusions

MD adherence correlates significantly with higher mental HRQoL scores in individuals with CD. Therefore, healthcare providers should promote the adoption of a Mediterranean gluten-free diet among patients as a holistic strategy to manage their condition and support overall well-being.

Author Contributions

Conceptualization, E.P. and A.S.; methodology, E.P. and A.S.; writing—original draft, E.P.; formal analysis, N.T.; investigation, A.-M.D. and M.K.; validation, A.M.; data curation, A.M.; writing—review and editing, A.G.M.; supervision: A.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of the Hellenic Mediterranean University (30922, 8 November 2024).

Informed Consent Statement

Informed consent was obtained electronically from all subjects involved in the study, which was conducted anonymously with no identifying information collected. The participants accessed the survey via Google Forms, where the first page included an information sheet summarizing the study’s purpose, objectives, and eligibility criteria. Consent was provided by requiring participants to check a box confirming their agreement before proceeding to the survey questions.

Data Availability Statement

The data presented in this study are available on request from the corresponding authors. The data are not publicly available due to ethical restrictions and the confidentiality guaranteed to participants.

Acknowledgments

The authors would like to thank all the participants who took part in this study for their time and valuable contribution.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Herrera-Quintana, L.; Navajas-Porras, B.; Vázquez-Lorente, H.; Hinojosa-Nogueira, D.; Corrales-Borrego, F.J.; Lopez-Garzon, M.; Plaza-Diaz, J. Celiac disease: Beyond diet and food awareness. Foods 2025, 14, 377. [Google Scholar] [CrossRef] [PubMed]
  2. Cebolla, Á.; Moreno, M.d.L.; Coto, L.; Sousa, C. Gluten immunogenic peptides as standard for the evaluation of potential harmful prolamin content in food and human specimen. Nutrients 2018, 10, 1927. [Google Scholar] [CrossRef] [PubMed]
  3. Fasano, A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann. N. Y. Acad. Sci. 2012, 1258, 25–33. [Google Scholar] [CrossRef]
  4. Caio, G.; Lungaro, L.; Segata, N.; Guarino, M.; Zoli, G.; Volta, U.; De Giorgio, R. Effect of gluten-free diet on gut microbiota composition in patients with celiac disease and non-celiac gluten/wheat sensitivity. Nutrients 2020, 12, 1832. [Google Scholar] [CrossRef]
  5. Therrien, A.; Kelly, C.P.; Schuppan, D. Celiac disease: Extraintestinal manifestations and associated conditions. J. Clin. Gastroenterol. 2020, 54, 8–21. [Google Scholar] [CrossRef]
  6. Simón, E.; Molina-Infante, J.; Cebolla, Á. The gluten-free diet for celiac disease: Critical insights to better understand clinical outcomes. Nutrients 2023, 15, 4013. [Google Scholar] [CrossRef]
  7. Pinto-Sanchez, M.I.; Blom, J.J.; Gibson, P.R.; Armstrong, D. Nutrition assessment and management in celiac disease. Gastroenterology 2024, 167, 116–131.e1. [Google Scholar] [CrossRef]
  8. Mędza, A.; Szlagatys-Sidorkiewicz, A. Nutritional status and metabolism in celiac disease: Narrative review. J. Clin. Med. 2023, 12, 5107. [Google Scholar] [CrossRef]
  9. Rinninella, E.; Cintoni, M.; Raoul, P.; Triarico, S.; Dionisi, T.; Gasbarrini, G.B.; Gasbarrini, A.; Mele, M.C. The healthy gluten-free diet: Practical tips to prevent metabolic disorders and nutritional deficiencies in celiac patients. Gastroenterol. Insights 2021, 12, 166–182. [Google Scholar] [CrossRef]
  10. Yemula, N. Gut microbiota in celiac disease. Ann. Gastroenterol. 2024, 37, 125–132. [Google Scholar] [CrossRef]
  11. Leo, S.; Leonard, M.M.; Valitutti, F.; Fasano, A. Gut dysbiosis: Cause or consequence of intestinal inflammation in celiac disease? Expert Rev. Gastroenterol. Hepatol. 2025, 19, 505–513. [Google Scholar] [CrossRef] [PubMed]
  12. Al-Sunaid, F.F.; Al-Homidi, M.M.; Al-Qahtani, R.M.; Al-Ashwal, R.A.; Mudhish, G.A.; Hanbazaza, M.A.; Al-Zaben, A.S. The influence of a gluten-free diet on health-related quality of life in individuals with celiac disease. BMC Gastroenterol. 2021, 21, 330. [Google Scholar] [CrossRef] [PubMed]
  13. Psylinakis, E.; Manidis, A.; Makris, F.; Thalassinos, N.; Markaki, A.; Kounelaki, V.; Sfakianaki, E.; Spyridaki, A. Gluten-free diet and health-related quality of life: The validated Hellenic version of the celiac dietary adherence test. Nutrients 2025, 17, 353. [Google Scholar] [CrossRef]
  14. Bascuñán, K.A.; Elli, L.; Vecchi, M. Mediterranean gluten-free diet: Is it a fair bet for the treatment of gluten-related disorders? Front. Nutr. 2020, 7, 583981. [Google Scholar] [CrossRef]
  15. Barber, T.M.; Kabisch, S.; Pfeiffer, A.F.H.; Weickert, M.O. The effects of the Mediterranean diet on health and gut microbiota. Nutrients 2023, 15, 2150. [Google Scholar] [CrossRef]
  16. Perrone, P.; D’Angelo, S. Gut Microbiota Modulation Through Mediterranean Diet Foods: Implications for Human Health. Nutrients 2025, 17, 948. [Google Scholar] [CrossRef]
  17. Khavandegar, A.; Heidarzadeh, A.; Angoorani, P.; Mohammadinasab, H.; Abdollahi, S.; Yousefi, B.; Sadeghi, A. Adherence to the Mediterranean diet can beneficially affect the gut microbiota composition: A systematic review. BMC Med. Genom. 2024, 17, 91. [Google Scholar] [CrossRef]
  18. Ullah, H.; Arbab, S.; Chang, C.; Bibi, S.; Muhammad, N.; Rehman, S.U.; Suleman; Ullah, I.; Hassan, I.U.; Tian, Y.; et al. Gut microbiota therapy in gastrointestinal diseases. Front. Cell Dev. Biol. 2025, 13, 1514636. [Google Scholar] [CrossRef]
  19. Spyridaki, A.; Psylinakis, E.; Chatzivasili, D.; Thalassinos, N.; Kounelaki, V.; Charonitaki, A.; Markaki, A. Adherence to the Mediterranean diet is linked to reduced psychopathology in female celiac disease patients. Psychol. Health Med. 2023, 28, 1634–1639. [Google Scholar] [CrossRef]
  20. Peresztegi, M.Z.; Szakács, Z.; Vereczkei, Z.; Dakó, E.; Dakó, S.; Lada, S.; Lemes, K.; Holczer, M.; Farkas, N.; Bajor, J. Mediterranean diet adherence in celiac patients: A nested cross-sectional study. Nutrients 2025, 17, 788. [Google Scholar] [CrossRef]
  21. Tristan Asensi, M.; Pagliai, G.; Lotti, S.; Corrao, A.; Colombini, B.; Giangrandi, I.; Sofi, F.; Dinu, M. Adherence to the Mediterranean diet and ultra-processed foods consumption in a group of Italian patients with celiac disease. Nutrients 2023, 15, 938. [Google Scholar] [CrossRef] [PubMed]
  22. Morreale, F.; Agnoli, C.; Roncoroni, L.; Sieri, S.; Lombardo, V.; Mazzeo, T.; Elli, L.; Bardella, M.T.; Agostoni, C.; Doneda, L.; et al. Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet? Nutr. Metab. Cardiovasc. Dis. 2018, 28, 1148–1154. [Google Scholar] [CrossRef] [PubMed]
  23. Burger, J.P.W.; de Brouwer, B.; IntHout, J.; Wahab, P.J.; Tummers, M.; Drenth, J.P.H. Systematic review with meta-analysis: Dietary adherence influences normalization of health-related quality of life in coeliac disease. Clin. Nutr. 2017, 36, 399–406. [Google Scholar] [CrossRef] [PubMed]
  24. Deepak, C.; Berry, N.; Vaiphei, K.; Prasad, K.K.; Sinha, S.K.; Sharma, A.K.; Singh, K. Quality of life in celiac disease and the effect of gluten-free diet. JGH Open 2018, 2, 124–128. [Google Scholar] [CrossRef]
  25. Pelletier, L.G.; Dion, S.C.; Slovinec-D’Angelo, M.; Reid, R. Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motiv. Emot. 2004, 28, 245–277. [Google Scholar] [CrossRef]
  26. Carfora, V.; Morandi, M.; Jelić, A.; Catellani, P. The psychosocial antecedents of the adherence to the Mediterranean diet: Motivational and mood-related predictors. Public Health Nutr. 2022, 25, 2710–2719. [Google Scholar] [CrossRef]
  27. Godos, J.; Guglielmetti, M.; Ferraris, C.; Frias-Toral, E.; Domínguez Azpíroz, I.; Lipari, V.; Di Mauro, A.; Furnari, F.; Castellano, S.; Galvano, F.; et al. Mediterranean diet and quality of life in adults: A systematic review. Nutrients 2025, 17, 577. [Google Scholar] [CrossRef]
  28. Sadeghi, O.; Keshteli, A.H.; Afshar, H.; Esmaillzadeh, A.; Adibi, P. Adherence to Mediterranean dietary pattern is inversely associated with depression, anxiety and psychological distress. Nutr. Neurosci. 2021, 24, 248–259. [Google Scholar] [CrossRef]
  29. Kennedy, D.O. B vitamins and the brain: Mechanisms, dose and efficacy—A review. Nutrients 2016, 8, 68. [Google Scholar] [CrossRef]
  30. Noah, L.; Dye, L.; Bois De Fer, B.; Mazur, A.; Pickering, G.; Pouteau, E. Effect of magnesium and vitamin B6 supplementation on mental health and quality of life in stressed healthy adults: Post-hoc analysis of a randomised controlled trial. Stress Health 2021, 37, 1000–1009. [Google Scholar] [CrossRef]
  31. Nagpal, R.; Shively, C.A.; Register, T.C.; Craft, S.; Yadav, H. Gut microbiome–Mediterranean diet interactions in improving host health. F1000Research 2019, 8, 699. [Google Scholar] [CrossRef]
  32. Clapp, M.; Aurora, N.; Herrera, L.; Bhatia, M.; Wilen, E.; Wakefield, S. Gut microbiota’s effect on mental health: The gut–brain axis. Clin. Pract. 2017, 7, 987. [Google Scholar] [CrossRef] [PubMed]
  33. Appleton, J. The gut–brain axis: Influence of microbiota on mood and mental health. Integr. Med. 2018, 17, 28–32. [Google Scholar]
  34. Singh, J.; Vanlallawmzuali; Singh, A.; Biswal, S.; Zomuansangi, R.; Lalbiaktluangi, C.; Singh, B.P.; Singh, P.K.; Vellingiri, B.; Iyer, M.; et al. Microbiota–brain axis: Exploring the role of gut microbiota in psychiatric disorders—A comprehensive review. Asian J. Psychiatry 2024, 97, 104068. [Google Scholar] [CrossRef] [PubMed]
  35. Ohrnberger, J.; Fichera, E.; Sutton, M. The relationship between physical and mental health: A mediation analysis. Soc. Sci. Med. 2017, 195, 42–49. [Google Scholar] [CrossRef]
  36. Alkhiari, R. Psychiatric and Neurological Manifestations of Celiac Disease in Adults. Cureus 2023, 15, e35712. [Google Scholar] [CrossRef]
  37. Thomas, A.; Thomas, A.; Butler-Sanchez, M. Dietary Modification for the Restoration of Gut Microbiome and Management of Symptoms in Irritable Bowel Syndrome. Am. J. Lifestyle Med. 2021, 16, 608–621. [Google Scholar] [CrossRef]
  38. Panagiotakos, D.B.; Pitsavos, C.; Arvaniti, F.; Stefanadis, C. Mediterranean diet score and dietary assessment. Public Health Nutr. 2007, 10, 114–118. [Google Scholar]
  39. Ware, J.E.; Kosinski, M.; Keller, S.D. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med. Care 1996, 34, 220–233. [Google Scholar] [CrossRef]
  40. Kontodimopoulos, N.; Pappa, E.; Niakas, D.; Tountas, Y. Validity of SF-12 in measuring health-related quality of life in the Greek population. Health Qual. Life Outcomes 2007, 5, 55. [Google Scholar] [CrossRef]
Gastrointestdisord 07 00043 g001
Figure 1. Comparison of physical health (PCS), mental health (MCS), and Mediterranean Diet Scores between the patient and control groups. Bars represent mean ± standard deviation.* Statistically significant difference between patients and controls. CD: Celiac disease; PCS: Physical Component Summary; MCS: Mental Component Summary; MedDiet Score: Mediterranean Diet Score.
Figure 1. Comparison of physical health (PCS), mental health (MCS), and Mediterranean Diet Scores between the patient and control groups. Bars represent mean ± standard deviation.* Statistically significant difference between patients and controls. CD: Celiac disease; PCS: Physical Component Summary; MCS: Mental Component Summary; MedDiet Score: Mediterranean Diet Score.
Gastrointestdisord 07 00043 g001
Gastrointestdisord 07 00043 g002
Figure 2. Correlation between MedDiet Score and MCS in the CD and control groups. CD: Celiac disease; MCS: Mental Component Summary; MedDiet Score: Mediterranean Diet Score.
Figure 2. Correlation between MedDiet Score and MCS in the CD and control groups. CD: Celiac disease; MCS: Mental Component Summary; MedDiet Score: Mediterranean Diet Score.
Gastrointestdisord 07 00043 g002
Table 1. Demographic profile of the CD and control groups.
Table 1. Demographic profile of the CD and control groups.
VariableCD Group
(N = 100)		%Control Group
(N = 100)		%
Gender
Male1515.0%1515.0%
Female8585.0%8585.0%
Marital Status
Single3434.0%4040.0%
Married5353.0%4444.0%
Divorced55.0%33.0%
Widowed11.0%00.0%
Other77.0%1313.0%
Educational Level
Secondary School22.0%11.0%
High School1313.0%1111.0%
College2121.0%1414.0%
University3737.0%5353.0%
Postgraduate/Doctorate2424.0%1919.0%
Other33.0%22.0%
Employment Status
Unemployed88.0%11.0%
Homemaker44.0%11.0%
Public Sector Employee1818.0%1919.0%
Private Sector Employee3737.0%4444.0%
Self-Employed1515.0%1818.0%
Retired11.0%11.0%
Student (School)22.0%22.0%
University Student88.0%1414.0%
Other77.0%00.0%
Income Level
Less than €5002929.0%1818.0%
Between €500–€10003333.0%4040.0%
More than €10003838.0%4242.0%
CD: Celiac disease.
Table 2. Comparison of physical health, mental health, and MedDiet Scores between the CD and control groups.
Table 2. Comparison of physical health, mental health, and MedDiet Scores between the CD and control groups.
VariableCD Group
(Mean ± SD)		Control Group
(Mean ± SD)		p-Value
Physical Component Summary43.80 ± 4.9945.45 ± 4.760.015 *
Mental Component Summary42.12 ± 8.0542.79 ± 6.560.738
MedDiet Score30.42 ± 3.8730.69 ± 4.970.709
CD: Celiac disease; MedDiet Score: Mediterranean Diet Score. * Significant differences between Patients and Controls.
Table 3. Mediterranean Diet Score categories in the CD and control groups.
Table 3. Mediterranean Diet Score categories in the CD and control groups.
MedDiet Score CategoryCD Group (N = 100)Control Group (N = 100)
Low adherence (0–20)1 (1.0%)1 (1.0%)
Moderate adherence (21–35)91 (91.0%)84 (84.0%)
High adherence (36–55)8 (8.0%)15 (15.0%)
CD: Celiac disease; MedDiet Score: Mediterranean Diet Score.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Psylinakis, E.; Thalassinos, N.; Dafouli, A.-M.; Kanaki, M.; Manidis, A.; Markaki, A.G.; Spyridaki, A. Mediterranean Diet and Health-Related Quality of Life in Patients with Celiac Disease. Gastrointest. Disord. 2025, 7, 43. https://doi.org/10.3390/gidisord7030043

AMA Style

Psylinakis E, Thalassinos N, Dafouli A-M, Kanaki M, Manidis A, Markaki AG, Spyridaki A. Mediterranean Diet and Health-Related Quality of Life in Patients with Celiac Disease. Gastrointestinal Disorders. 2025; 7(3):43. https://doi.org/10.3390/gidisord7030043

Chicago/Turabian Style

Psylinakis, Emmanuel, Nikolaos Thalassinos, Aikaterini-Maria Dafouli, Maria Kanaki, Alexios Manidis, Anastasia G. Markaki, and Aspasia Spyridaki. 2025. "Mediterranean Diet and Health-Related Quality of Life in Patients with Celiac Disease" Gastrointestinal Disorders 7, no. 3: 43. https://doi.org/10.3390/gidisord7030043

APA Style

Psylinakis, E., Thalassinos, N., Dafouli, A.-M., Kanaki, M., Manidis, A., Markaki, A. G., & Spyridaki, A. (2025). Mediterranean Diet and Health-Related Quality of Life in Patients with Celiac Disease. Gastrointestinal Disorders, 7(3), 43. https://doi.org/10.3390/gidisord7030043

Article Metrics

Back to TopTop