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The Implications of Celiac Disease and the GFD on Health Outcomes

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 20 July 2026 | Viewed by 7001

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Special Issue Editors

Dr. Anne Roland Lee

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Guest Editor

Celiac Disease Center at Columbia University, New York, NY 10032, USA
Interests: celiac disease; gluten-free diet

Dr. Suneeta Krishnareddy

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Guest Editor

Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA
Interests: inflammatory bowel disease; endoscopy; gastrointestinal diseases; capsule endoscopy

Dr. Stephanie M. Moleski

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Guest Editor Assistant

Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
Interests: gastroenterology; celiac disease; gastrointestinal motility disorders

Special Issue Information

Dear Colleagues,

While the gluten-free diet (GFD) is the only treatment for celiac disease (CeD), there are many nutritional concerns regarding the nutritional adequacy of this diet. A standard GFD is often low in fiber and B vitamins, but higher in simple refined carbohydrates, fats, and sugars. Gut flora is negatively impacted by increased consumption of refined carbohydrates, processed foods, and sugars. Whole grains and a fiber-rich diet are associated with increased favorable gut flora.

This Special Issue aims to collect original research articles and reviews that explore the nutritional imbalances commonly observed in GFD, especially their effects on gut microbiota and overall intestinal health. Submissions that investigate strategies for improving dietary quality of individuals with CeD (including interventions to enhance fiber intake, optimize micronutrient status, and support gut health) are encouraged). We also welcome contributions that offer evidence-based dietary guidance and practical solutions for promoting a balanced and gut-friendly GFD.

We look forward to your contributions.

Dr. Anne Roland Lee
Dr. Suneeta Krishnareddy
Guest Editors

Dr. Stephanie M. Moleski
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

celiac disease
gluten-free diet
gut health
diet and microbiome

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Published Papers (5 papers)

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Research

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16 pages, 599 KB

Open AccessArticle

Adaptation and Validation of the Gluten-Free Perceived Nutrition Environment Measures Survey (NEMS-P-GF) and Its Association with Gluten-Free Diet Adherence Among Adults with Celiac Disease in Chile

by María Jesús Vega-Salas, Alejandra Parada, Danae Hermosilla-Llanca, Loni Berkowitz, Lorena Rodríguez Osiac, Daniel Egaña Rojas and Attilio Rigotti

Nutrients 2026, 18(6), 929; https://doi.org/10.3390/nu18060929 - 16 Mar 2026

Viewed by 576

Abstract

Background/Objectives: Strict adherence to a gluten-free diet (GFD) is the only effective treatment for celiac disease (CeD) but remains challenging due to structural and environmental barriers. Evidence on these determinants in Latin America is scarce. This study aimed to adapt and validate the Gluten-Free Perceived Nutrition Environment Measures Survey (NEMS-P-GF) for adults with CeD in Chile and examine its association with GFD adherence. Methods: A cross-sectional online survey (October 2023–January 2024) included adults (≥18 years) with biopsy- or serology-confirmed CeD (n = 233). The questionnaire collected sociodemographic and clinical data, assessed adherence using the Celiac Dietary Adherence Test (CDAT; good < 13, poor ≥ 13), and measured perceptions of home and supply food environments via the adapted NEMS-P-GF. Construct validity was tested using exploratory factor analysis and reliability with Cronbach’s α and McDonald’s ω. Associations with adherence were analyzed using Mann–Whitney U. Results: NEMS-P-GF domains showed adequate validity (KMO 0.71–0.81; Bartlett’s p < 0.001) and acceptable-to-excellent reliability (α/ω = 0.70–0.90). Participants with good vs. poor adherence perceived more supportive environments, particularly at home (median 4.79 vs. 1.29; p < 0.01) and globally (1.72 vs. −7.25; p < 0.01). Supply environments were perceived as less supportive due to limited availability and high prices (median −3.68 and −7.78), with smaller differences between adherence groups (p = 0.018). Conclusions: Supportive home environments were strongly associated with better GFD adherence, while supply environments remained broadly restrictive, showing modest but significant differences between adherence groups. The NEMS-P-GF demonstrated preliminary evidence of good psychometric properties and offers a valid, context-sensitive tool to assess GF food environments and inform public health strategies for CeD populations. Full article

(This article belongs to the Special Issue The Implications of Celiac Disease and the GFD on Health Outcomes)

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18 pages, 601 KB

Open AccessArticle

Food Insecurity and Gastrointestinal Symptom Burden in Adults with Celiac Disease: A Cross-Sectional Study

by Katrina S. Rbeiz, Madison A. Hooper, Hana F. Zickgraf, Alyson Basil, Joanna Perl and Dawn W. Adams

Nutrients 2026, 18(5), 873; https://doi.org/10.3390/nu18050873 - 9 Mar 2026

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Abstract

Background/Objectives: Food insecurity (FI) is associated with adverse physical and mental health outcomes and poses unique challenges for individuals with celiac disease (CD), who must adhere to a lifelong, strict gluten-free diet (GFD) as their sole treatment. Gluten-free foods are often more expensive and less accessible, potentially exacerbating dietary burden and symptom severity. This study aimed to examine associations between food insecurity and gastrointestinal symptoms, dietary burden, disordered eating symptoms, and mental health outcomes in adults with CD. Methods: Participants were 397 adults with CD who completed a routine pre-visit screener at a tertiary celiac disease clinic in the southeastern United States. Food insecurity was assessed using the Hunger Vital Signs. Measures included gastrointestinal symptoms (GSRS), impact of following a gluten-free diet (IGFDQ), avoidant/restrictive eating (NIAS), eating disorder psychopathology (EDE-Q7), anxiety (GAD-2), and depression (PHQ-2). Group comparisons between food-secure and participants screening positive for food insecurity (high-risk of FI) were conducted using independent t-tests or Mann–Whitney U tests as appropriate. Missing data were handled using multiple imputations. Results: A total of 15.6% of participants were at high risk of FI. Compared to food-secure individuals, participants at high-risk of FI reported significantly greater gastrointestinal symptom severity, including bloating, constipation, diarrhea, and overall symptom burden. Participants at high risk of FI also reported significantly greater perceived burden of adhering to a gluten-free diet. Additionally, higher levels of avoidant/restrictive eating symptoms and shape/weight overvaluation were observed among high-risk FI individuals, though group differences in anxiety and depression symptoms were not statistically significant. Conclusions: FI is associated with greater gastrointestinal symptom burden and increased difficulty adhering to a gluten-free diet among adults with celiac disease. These findings highlight risk of FI as a clinically relevant barrier to effective disease management and underscore the importance of routine screening and targeted support for high-risk FI individuals with CD. Full article

(This article belongs to the Special Issue The Implications of Celiac Disease and the GFD on Health Outcomes)

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13 pages, 486 KB

Open AccessArticle

Factors Affecting Gluten-Free Dietary Adherence in Patients with Neurological Gluten-Related Disease

by Iain D. Croall, Marios Hadjivassiliou, David S. Sanders, Nick Trott and Nigel Hoggard

Nutrients 2026, 18(3), 480; https://doi.org/10.3390/nu18030480 - 1 Feb 2026

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Abstract

Background/Objectives: The gluten-free diet (GFD) is the primary treatment for patients with neurological gluten-related disease, which may occur with or without coeliac disease (CD). Dietary adherence is arguably most important in such patients, as ongoing gluten exposures have been shown to exacerbate irreversible neurological deterioration. We utilised a cross-sectional postal questionnaire to explore factors affecting dietary adherence in a large sample of such patients, highlighting potential areas of dietetic need. Methods: Patients returned a postal questionnaire (N = 225), which assessed self-reported GFD adherence by the Biagi scale and a visual analogue scale. CD status was ascertained, alongside symptomatology and mood (via the Hospital Anxiety and Depression Scale). Dietary knowledge was tested by a “quiz” where respondents identified which of 10 foodstuffs should be avoided on a GFD. Results: Self-reported adherence was high across the cohort, but was significantly higher in those with CD than those without. Patients with CD more often reported a number of gastrointestinal symptoms as acute reactions if they were to eat gluten. Similarly, the CD subgroup reported greater overall acute discomfort following gluten, while across the cohort greater such discomfort correlated with greater dietary adherence. Overall, 6.2% of the participants both reported strict diets (scoring ≥ 90 on the visual analogue scale) but via the quiz indicated an erroneous belief that they could eat a gluten-containing foodstuff. Lower adherence was correlated with higher depressive scores, with post hoc analyses finding that this was driven by patients without CD. Conclusions: This study highlights a need for increased dietary support in patients with neurological gluten sensitivity, particularly when there is no co-diagnosis of CD. Therapies targeting depression may additionally bolster dietary adherence. Full article

(This article belongs to the Special Issue The Implications of Celiac Disease and the GFD on Health Outcomes)

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10 pages, 197 KB

Open AccessEditor’s ChoiceArticle

Accommodating Celiac Disease in Higher Education: Evidence-Informed National Recommendations

by Vanessa Weisbrod, Meghan Donnelly McKeon, Emma Kowzun, Marilyn Grunzweig Geller, Jackie Jossen, Marisa Gallant Stahl, Maureen M. Leonard, Mary Shull, Janis Arnold, Jennifer Kumin, Sharon Weston, Anne R. Lee, Mary Vargas, Dale Lee, Allyson West, Catherine Raber, Katherine Vera Sachs and Ritu Verma

Nutrients 2026, 18(2), 294; https://doi.org/10.3390/nu18020294 - 16 Jan 2026

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Abstract

Objectives: We aimed to develop expert-informed recommendations for colleges and universities to support students with celiac disease (CeD) managing a gluten-free (GF) diet. Methods: A multidisciplinary panel of 40 stakeholders, including physicians, dietitians, a disability rights attorney, university staff, and students, was convened by the Celiac Disease Foundation to create expert-based and experience-informed recommendations. Over a 6-month period, the group conducted literature reviews, stakeholder interviews, and expert consensus discussions to identify common barriers and accommodations aligned with federal disability law. The expert panel collaboratively developed and revised an initial set of recommendations. Two rounds of structured voting were held during which panelists provided feedback to refine content and ensure clarity. All final recommendations were adopted with at least 90% of panelists voting in support. Results: The panel identified 24 accommodations across four domains: academics, housing, dining, and campus life. Academic recommendations include flexibility for illness-related absences, support for remote learning, and classroom modifications. Housing recommendations emphasize access to priority placement, appropriate appliances, and proximity to safe dining. Dining accommodations address GF food availability, ingredient transparency, staff training, and meal plan flexibility. Campus life recommendations ensure full participation in athletics, study abroad, social events, and internships, with supports for psychosocial well-being. Conclusions: This manuscript presents the first expert-informed recommendations focused specifically on the needs of college students with CeD. These recommendations are intended to support institutions as they develop strategies to enhance access to GF food, quality of life, educational supports, and student experience for those living with this chronic autoimmune condition. Full article

(This article belongs to the Special Issue The Implications of Celiac Disease and the GFD on Health Outcomes)

Review

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12 pages, 500 KB

Open AccessReview

Ironing Out the Deficiency: Tracking Iron in Celiac Disease Before and After the Gluten-Free Diet

by Patricia Dillawn, Sadie Nagle, Edwin Liu and Marisa Gallant Stahl

Nutrients 2026, 18(4), 590; https://doi.org/10.3390/nu18040590 - 11 Feb 2026

Viewed by 1753

Abstract

Celiac disease (CeD) is a gluten-induced immune-mediated enteropathy that preferentially involves the proximal duodenum. Consequently, iron deficiency is common in CeD, impacting at least 10% of newly diagnosed individuals. In this narrative review, we aim to investigate the mechanisms, prevalence, treatment, and monitoring of iron deficiency and the impacts of a gluten-free diet (GFD) on iron deficiency in individuals with CeD. We will also review the role of and approach to iron supplementation in this population. Specifically, we will explore whether mucosal healing on a GFD is sufficient for the management of iron deficiency amongst individuals with CeD. Full article

(This article belongs to the Special Issue The Implications of Celiac Disease and the GFD on Health Outcomes)

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