Celiac disease and gluten-free diet-related nutritional knowledge among medical students and internship doctors in Palestine: a cross-sectional training-needs assessment

Abstract Background Celiac disease management requires lifelong adherence to a gluten-free diet, alongside nutritional monitoring, diet-quality assessment, and dietitian support. Data on Palestinian medical trainees’ preparedness for these tasks are limited. This study assessed celiac disease knowledge, gluten-free-diet-related nutritional knowledge, and perceived barriers to gluten-free diet adherence among medical students and internship doctors in the West Bank. Methods A cross-sectional study was conducted among medical students and internship doctors in the West Bank, Palestine. Main analyses included participants who had heard of celiac disease and had no personal or family diagnosis. An adapted questionnaire assessed general celiac disease knowledge, nutritional-deficiency knowledge, attitudes toward vitamin D monitoring and dietitian involvement, and perceived barriers to gluten-free diet adherence. Adequate general celiac disease knowledge was defined as a score of at least 17/27, and adequate nutritional-deficiency knowledge as at least 13/21. Results Among 479 participants (253 medical students and 226 internship doctors), adequate celiac disease knowledge was observed in 138 (28.8%), whereas adequate nutritional-deficiency knowledge was observed in 84 (17.5%). Only 231 (48.2%) identified upper gastrointestinal endoscopy with small-intestinal biopsy as the confirmatory examination. Knowledge of gluten-free product composition was limited: 156 (32.6%) recognized that processed gluten-free foods may contain more saturated fat, and 96 (20.0%) correctly rejected the statement that they contain more dietary fiber. In the adjusted pooled model, female gender was associated with higher odds of adequate celiac disease knowledge (aOR 2.48, 95% CI 1.56–3.93), whereas medical students had lower odds than internship doctors (aOR 0.45, 95% CI 0.26–0.80). No factor was independently associated with adequate nutritional-deficiency knowledge. The total celiac disease knowledge score and the total nutritional-deficiency knowledge score were moderately positively correlated (Spearman’s ρ = 0.433). The most frequently perceived barriers were high cost and limited availability of gluten-free products (74.5%), lack of knowledge about gluten-free foods (68.7%), and reliance on wheat-based foods (55.3%). Conclusions Palestinian medical trainees showed limited celiac disease knowledge and particularly low gluten-free-diet-related nutritional knowledge. Medical curricula should integrate micronutrient monitoring, diet-quality assessment, dietitian referral, and culturally feasible counseling into celiac disease education.