A mixed-methods study of knowledge, attitudes, and practices related to gluten-free diets in india

Recent evidence suggests a growing popularity of gluten-free diets (GFDs) beyond clinically indicated contexts in low- and middle-income countries. However, a comprehensive investigation of public perceptions, motivations, and professional challenges related to both medically and non-medically indicated GFD adoption remains limited. Therefore, we conducted a mixed-methods study to explore the perspectives of dietetic professionals and assess the knowledge, attitudes, and practices (KAP) related to gluten and GFDs among a sample of urban adults aged 18–45 years in India. The clinical and nutritional considerations for GFD were examined through in-depth interviews ( n = 9) and an online survey was conducted among adults ( n = 285) to assess their KAP. Thematic analyses revealed fragmented public understanding, symptom-led self-diagnosis, influence of “anti-inflammatory” narratives, concerns regarding nutritional adequacy of GFDs, and the need to leverage traditional food systems. The findings indicated limited knowledge regarding gluten (50.9%), and GFDs (38.6%). Reasons for preferring gluten free products were reported as perceived health benefits (19.8%), weight loss (26.4%) and no specific reason (32.1%). Rice (58.9%), lentils (55.8%), and millets (30.9%) were the most commonly (almost every day) consumed gluten-free staples. In contrast, consumption of oats (7.7%), soybean/soy flour (1.4%), and chickpea flour (0.7%) was considerably lower. The study provides timely insights into the drivers of the GFD trend within India’s rapidly evolving urban nutrition landscape.