Diet patterns in an ethnically diverse pediatric population with celiac disease and chronic gastrointestinal complaints

Clin Nutr ESPEN. 2019 Apr:30:73-80. doi: 10.1016/j.clnesp.2019.02.004. Epub 2019 Mar 6.


Introduction: Celiac disease (CD) is an autoimmune disease requiring lifelong adherence to the gluten-free diet (GFD). The GFD has significant nutritional limitations which may result in poor diet quality (DQ). We hypothesized that biopsy-proven children with CD (CCD) would have dietary patterns characterized by high saturated fat/simple sugar intake with a low micronutrient density contributing to lower DQ when compared to children with mild-gastrointestinal complaints (GI-CON). In addition, we hypothesized that ethnicity may further impact DQ.

Methods: Socio-demographic (age, CD duration, parent/child ethnicity, education), household characteristics, anthropometric, dietary intake (24-h recalls), gastrointestinal pain and adherence was collected in CCD (n = 243) and GI-CON (n = 148). Dietary patterns were determined using k-mean Cluster Analysis.

Results: GI-CON had significantly lower DQ than CCD (p < 0.001). Most CCD and GI-CON (>80%) had dietary patterns characterized by1) Western Diet (Cluster 1: %BMR: 110-150, low DQ, high fat, moderate CHO, high sodium) and 2) High Fat-Western Diet (Cluster 2: %BMR:130-150, low DQ, high Fat, high processed meats, high fat dairy products, CHO. Fewer children (<20%) had Prudent, Lower Fat/High Carbohydrate dietary patterns (% BMR:100-150, higher DQ, lower fat/sodium, higher CHO) with a greater proportion of non-Caucasian CCD consuming a Prudent dietary pattern. Seventy-seven percent and 37.5% of CCD and GI-CON, respectively, did not meet estimated average requirements for folate (p < 0.001).

Conclusions: CCD and GI-CON have predominantly Western dietary patterns with low DQ, particularly GI-CON. Non-caucasian CCD consume more prudent dietary patterns with higher DQ. Nutrition education is warranted to ensure optimal DQ in children with chronic gastrointestinal diseases.

Keywords: Celiac disease; Children and youth; Chronic gastrointestinal complaints; Diet patterns; Ethnically diverse.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anthropometry
  • Body Mass Index
  • Canada / epidemiology
  • Celiac Disease / diet therapy*
  • Celiac Disease / epidemiology
  • Celiac Disease / ethnology*
  • Celiac Disease / physiopathology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diet, Gluten-Free*
  • Dietary Carbohydrates
  • Dietary Fats
  • Energy Intake
  • Ethnicity
  • Feeding Behavior / ethnology*
  • Feeding Behavior / psychology
  • Female
  • Humans
  • Male
  • Micronutrients / administration & dosage
  • Nutrition Assessment
  • Nutritional Status
  • Nutritive Value
  • Patient Compliance / ethnology*
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data


  • Dietary Carbohydrates
  • Dietary Fats
  • Micronutrients