Introduction

A strict lifelong gluten-free diet (GFD) is the mainstay of treatment for coeliac disease (CD). However, persistence of gastrointestinal symptoms in coeliac patients despite a GFD is a relevant clinical scenario. The impact of highly processed foods (HPF) intake and the adherence to a correct Mediterranean diet (MD) on these symptoms, the quality of life (QOL), and the metabolic profile of coeliac patients on a GFD is not well understood. This study aimed to investigate the influence of HPF and MD on gastrointestinal symptoms, QOL, and metabolic profile in coeliac patients on a GFD. We hereby present partial data of this ongoing study.

Aims & Methods

Adult CD patients were prospectively enrolled between November-2023 and March-2024 at four Italian referral centers. For each enrolled patient, the following data were recorded: persistent symptoms over the previous 12 months and in the 7 days prior to enrolment by using the GSRS-CeD, adherence to a GFD, adherence to a MD evaluated by means of the Pyramid-based Mediterranean Diet Score (PyrMDS), the consumption of highly processed food evaluated by means of the sQ-HPF, the Celiac Disease-specific Quality of Life Scale (CD-QOL) and metabolic profile. These data were subsequently statistically analized.

Results

A total of 121 patients (83F, mean age 44±15 years) were enrolled. Overall, 61% of patients reported persistent gastrointestinal symptoms despite a GFD. Patients with persistent symptoms were more likely to be female (78% vs 53%, p<0.01), to have a lower HPF intake (26% vs 30%, p=0.02), a higher GSRS-CeD score (median 3 vs 18.5, p<0.001), and lower CD-QoL scores (mean CD-QoL 80 vs 88, p<0.001), but did not have higher PyrMDS scores (p=0.21). PyrMDS was inversely correlated with HPF intake (r=-0.20, p=0.03) and serum triglycerides (r=-0.22, p=0.05), and positively correlated with HDL cholesterol (r=0.20, p=0.08). At multivariate logistic regression adjusted for age and sex, persistence of gastrointestinal symptoms despite a GFD was associated with female sex (p<0.01), lower HPF intake (p=0.04), but not adherence to MD (p=0.31).

Conclusion

Persistence of gastrointestinal symptoms in coeliac patients despite a GFD is common, but unrelated to the adherence to a MD. Female sex and lower intake of HPF were associated with persistence on gastrointestinal symptoms despite a GFD despite a better metabolic profile. Optimising dietary treatment of coeliac patients with persistent gastrointestinal symptoms despite a GFD requires expert nutritional counselling.