Changes in gluten-free diet adherence and growth parameters among children with celiac disease during the COVID-19 pandemic.

Objectives: Strict exclusion of gluten is the cornerstone of celiac disease (CD) management; nevertheless, maintaining dietary adherence remains challenging. The COVID-19 pandemic may have influenced dietary adherence in children with CD. This study aimed to investigate the association between the COVID-19 pandemic and gluten-free diet (GFD) adherence and anthropometric measurements. Methods: This retrospective longitudinal cohort study with a cross-sectional survey component included 81 pediatric patients with CD (67.9% female; mean age 14.9 ± 3.4 years) who had been following a GFD for at least one year before the pandemic. Demographic, clinical, laboratory, and anthropometric data from the pre-pandemic, restriction, and post-pandemic periods were obtained from medical records. Dietary adherence was assessed via a structured telephone questionnaire. Participants reporting either complete avoidance of gluten or fewer than six inadvertent gluten exposures annually were categorized as self-reported adherent. Serological adherence was defined by a negative tTG-IgA result. Results: At the beginning of the pandemic in March 2020, the mean duration of GFD was 3.9 ± 2.4 years. At the time of the survey, self-reported adherence was 67.9% (55/81), whereas serological adherence was 77.1% (54/70). During the pandemic, 49.4% of participants reported no change in dietary adherence, 33.3% reported increased adherence, and 17.3% reported decreased adherence. Serological adherence differed significantly across the three longitudinal assessment periods (Cochran's Q = 31.818, Conclusion: Serological adherence was significantly higher during both the COVID-19 restriction and post-pandemic periods than during the pre-pandemic period, while no significant changes in anthropometric measurements were observed.