Nutritional surveillance and diet adherence in pediatric celiac disease: A multidisciplinary case–control study within a clinical nutrition model

BACKGROUND & AIMS: Adherence to a gluten-free diet (GFD) is the cornerstone of celiac disease (CD) management, yet maintaining long-term adherence remains challenging, particularly in adolescence. Evidence on the nutritional profile and dietary adherence of pediatric CD populations in Southern Europe is scarce. This study aimed to compare the nutritional status of children and adolescents with CD to healthy peers and to explore the relationship between GFD duration, age at diagnosis, and dietary adherence. METHODS: This observational case-control study included 80 biopsy-confirmed pediatric CD patients recruited during routine hospital follow-up and 80 age- and sex-matched healthy controls. Anthropometric measurements were performed according to WHO standardized procedures, and BMI z-scores were calculated using WHO AnthroPlus reference data. Gluten-free diet adherence was assessed through anti-tTG IgA serology. Statistical analysis included assessment of normality using the Shapiro-Wilk test, followed by independent t-tests and chi-square or Fisher's exact tests, as appropriate. RESULTS: Normal BMI z-scores were observed in 65% of CD patients and 61.3% of controls (p = 0.214). Overweight/obesity was present in both groups (CD: 21.3%; controls: 31.3%). No significant association was found between GFD duration and BMI z-score (p = 0.406). Earlier CD diagnosis was associated with better dietary adherence (p = 0.0015). CONCLUSION: Children and adolescents with celiac disease presented similar BMI profiles to healthy peers, with the presence of overweight in both groups. Earlier diagnosis was associated with better dietary adherence.