Nutritional Status, Dietary Intake, and Adherence to the Mediterranean Diet of Children with Celiac Disease on a Gluten-Free Diet: A Case-Control Prospective Study

Nutrients. 2020 Jan 4;12(1):143. doi: 10.3390/nu12010143.


The only effective treatment for celiac disease (CD) is a life-long strict gluten-free diet (GFD). Nutritional adequacy of the GFD has remained controversial and a matter of debate for a long time. No large case-control studies on children regarding the nutritional adequacy of the GFD has been performed. In this study, children diagnosed with CD on a GFD for ≥ 2 years were recruited. Controls were age and gender-matched healthy children not affected with CD. In both groups, anthropometric measurements and energy expenditure information were collected. Dietary assessment was performed by a 3-day food diary. Adherence to the Mediterranean diet was estimated by the KIDMED index. Overall, 120 children with CD and 100 healthy children were enrolled. No differences were found between CD children and controls in anthropometric measurements and energy expenditure. In the CD group, the daily intake of fats was significantly higher while the consumption of fiber was lower in comparison with the control group. The median KIDMED index was 6.5 in CD children and 6.8 in healthy controls. The diet of children with CD in this study was nutritionally less balanced than controls, with a higher intake of fat and a lower intake of fiber, highlighting the need for dietary counseling.

Keywords: celiac disease; gluten; gluten-free diet; nutrient; nutritional adequacy.

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Celiac Disease / diet therapy*
  • Celiac Disease / physiopathology
  • Child
  • Child, Preschool
  • Diet Records
  • Diet Surveys
  • Diet, Gluten-Free / statistics & numerical data*
  • Diet, Mediterranean / statistics & numerical data*
  • Dietary Fats / analysis
  • Dietary Fiber / analysis
  • Eating / physiology*
  • Energy Metabolism
  • Female
  • Humans
  • Male
  • Nutrition Assessment
  • Nutritional Status*
  • Prospective Studies


  • Dietary Fats
  • Dietary Fiber