Assessing Nutritional Quality and Adherence to the Gluten-free Diet in Children and Adolescents with Celiac Disease

Publication: Canadian Journal of Dietetic Practice and Research
17 February 2015


Purpose: Little is known regarding nutritional adequacy of the gluten free diet (GFD) in children and adolescents with celiac disease (CD). The study aim was to examine macro- and micronutrient intake in children with CD.
Methods: A cross-sectional study was conducted in children and adolescents (4–18 years of age) with CD (n = 32) and healthy controls (n = 32). Macro- and micronutrient intake, and glycemic index (GI) and glycemic load (GL) intake was assessed using validated measures. Diet quality was assessed using the Canadian Healthy Eating Index (HEI-C) and the Alberta Nutrition Guidelines. Values are shown as mean ± SE.
Results: Age (10.4 ± 0.7years vs 8.7 ± 0.7 years; P = 0.06), weight-for-age z score (P = 0.27), and height-for-age z score (P = 0.23) were not different between groups. CD children consumed more fibre (15.9 ± 1.2 g per day(CD) vs 10.8 ± 0.8 g per day (controls); P < 0.001), had higher GI (CD: 54 ± 2 vs 48 ± 1; P < 0.01) and GL (CD: 118 ± 8 vs 93 ± 7; P = 0.02), and lower folate (146.7 ± 15.3 (CD) vs 245.4 ± 21.8 µg per day (controls); P < 0.001) than controls. No differences in HEI-C scores (≤ and > 80) were observed between groups (P > 0.05).
Conclusion: Children with CD had high intakes of fibre, GI, and GL and lower intakes of folate. This has implications for dietary counselling in this population.


Objectif. Il existe peu de données sur la suffisance nutritionnelle du régime sans gluten (RSG) chez les enfants et les adolescents atteints de la maladie cæliaque (MC). L'objectif de l’étude était d'examiner l'apport en oligo-éléments et en macronutriments des enfants aux prises avec la MC.
Méthodes. Une étude transversale a été menée auprès d'enfants et d'adolescents (âgés de 4 à 18 ans) atteints de la MC (n = 32) et de témoins en santé (n = 32). L'apport en oligo-éléments et en macronutriments, l'indice glycémique (IG) et la charge glycémique (CG) ont été évalués à l'aide de mesures validées. La qualité du régime a été évaluée en fonction du Canadian-Healthy Eating Index (C-HEI) et des Alberta Nutrition Guidelines. Les valeurs sont présentées sous la forme moyenne ± erreur-type.
Résultats. L’âge (10,4 ± 0,7 années vs 8,7 ± 0,7 années; p = 0,06), l’écart réduit du poids pour l’âge (p = 0,27) et l’écart réduit de la taille pour l’âge (p = 0,23) ne variaient pas beaucoup d'un groupe à l'autre. Les enfants aux prises avec la MC consommaient plus de fibres (15,9 ± 1,2 g par jour [MC] vs 10,8 ± 0,8 g par jour [témoins]; p < 0,001), avaient un IG (MC : 54 ± 2 vs 48 ± 1; p < 0,01) et une CG (MC : 118 ± 8 vs 93 ± 7; p = 0,02) plus élevés et un plus faible apport en acide folique (146,7 ± 15,3 [MC] vs 245,4 ± 21,8 µg par jour [témoins]; p < 0,001) que les témoins. Aucune différence n'a été observée entre les groupes (p > 0,05) relativement aux scores du C-HEI (≤ et > 80).
Conclusion. Les enfants atteints de la MC consommaient plus de fibres et avaient un IG et une CG plus élevés que les témoins en santé, mais leur apport en acide folique était inférieur. Ces résultats ont des répercussions sur le counseling diététique destiné à cette population.

Get full access to this article

View all available purchase options and get full access to this article.


Green PH and Cellier C Celiac disease N Engl J Med. 2007 357 17 1731 -43
Goddard CJ and Gillett HR Complications of coeliac disease: are all patients at risk? Postgrad Med J. 2006 82 973 705 -12
Mager DR, Qiao J, and Turner J Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease Eur J Clin Nutr. 2012 66 4 488 -95
Turner J, Pellerin G, and Mager D Prevalence of metabolic bone disease in children with celiac disease is independent of symptoms at diagnosis J Pediatr Gastroenterol Nutr. 2009 49 5 589 -93
Roma E, Roubani A, Kolia E, Panayiotou J, Zellos A, and Syriopoulou VP Dietary compliance and life style of children with coeliac disease J Hum Nutr Diet. 2010 23 2 176 -82
Charalampopoulos D, Panayiotou J, Chouliaras G, Zellos A, Kyritsi E, and Roma E Determinants of adherence to gluten-free diet in Greek children with coeliac disease: a cross-sectional study Eur J Clin Nutr. 2013 67 6 615 -9
Ohlund K, Olsson C, Hernell O, and Ohlund I Dietary shortcomings in children on a gluten-free diet J Hum Nutr Diet. 2010 23 3 294 -300
Zuccotti G, Fabiano V, Dilillo D, Picca M, Cravidi C, and Brambilla P Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products J Hum Nutr Diet. 2013 26 5 436 -44
Hopman EG, le Cessie S, von Blomberg BM, and Mearin ML Nutritional management of the gluten-free diet in young people with celiac disease in The Netherlands J Pediatr Gastroenterol Nutr. 2006 43 1 102 -8
Hallert C, Grant C, Grehn S, Granno C, Hulten S, Midhagen G, et al. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years Aliment Pharmacol Ther. 2002 16 7 1333 -9
Kautto E, Ivarsson A, Norstrom F, Hogberg L, Carlsson A, and Hornell A Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries J Hum Nutr Diet. 2014 27 1 41 -53
Marsh MN Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’) Gastroenterology. 1992 102 1 330 -54
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States Adv Data. 2000 8 314 1 -27
Prazny M, Skrha J, Limanova Z, Vanickova Z, Hilgertova J, Prazna J, et al. Screening for associated autoimmunity in type 1 diabetes mellitus with respect to diabetes control Physiol Res. 2005 54 1 41 -8
Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, and Misra M Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa J Am Diet Assoc. 2009 109 3 479 -485.e3
Downs SM, Farmer A, Quintanilha M, Berry TR, Mager DR, Willows ND, et al. Alberta nutrition guidelines for children and youth: awareness and use in schools Can J Diet Pract Res. 2011 72 3 137 -40
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The report on dietary reference intakes for calcium and vitamin D from the institute of medicine: what clinicians need to know J Clin Endocrinol Metab. ;96 2011 2011 1 53 -8
Trumbo P, Schlicker S, Yates AA, and Poos M Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids J Am Diet Assoc. 2002 102 11 1621 -30
Woodruff SJ and Hanning RM Development and implications of a revised Canadian Healthy Eating Index (HEIC-2009) Public Health Nutr. 2010 13 6 820 -5
Woodruff SJ, Hanning RM, Lambraki I, Storey KE, and McCargar L Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping Body Image. 2008 5 4 404 -8
Foster-Powell K, Holt SH, and Brand-Miller JC International table of glycemic index and glycemic load values: 2002 Am J Clin Nutr. 2002 76 1 5 -56
Brand Miller J, Colagiuri S, and Foster-Powell K The glycemic index is easy and works in practice Diabetes Care. 1997 20 10 1628 -9
Bellini A, Zanchi C, Martelossi S, Di Leo G, Not T, and Ventura A Compliance with the gluten-free diet: the role of locus of control in celiac disease J Pediatr. 2011 158 3 463 -6.e5
Rajani S, Alzaben A, Shirton L, Persad R, Huynh HQ, Mager DR, et al. Exploring anthropometric and laboratory differences in children of varying ethnicities with celiac disease Can J Gastroenterol Hepatol. 2014 28 7 351 -4
Mager DR, Iniguez IR, Gilmour S, Yap J. The effect of a low fructose and low glycemic index/load (FRAGILE) dietary intervention on indices of liver function, cardiometabolic risk factors, and body composition in children and adolescents with nonalcoholic fatty liver disease (NAFLD). J Parenter Enteral Nutr. 2013. doi: 10.1177/0148607113501201.
De Marchi S, Chiarioni G, Prior M, and Arosio E Young adults with coeliac disease may be at increased risk of early atherosclerosis Aliment Pharmacol Ther. 2013 38 2 162 -9
El Hayek J, Egeland G, and Weiler H Vitamin D status of Inuit preschoolers reflects season and vitamin D intake J Nutr. 2010 140 10 1839 -45
Mark S, Lambert M, Delvin EE, O'Loughlin J, Tremblay A, and Gray-Donald K Higher vitamin D intake is needed to achieve serum 25(OH)D levels greater than 50 nmol/l in Quebec youth at high risk of obesity Eur J Clin Nutr. 2011 65 4 486 -92
Vatanparast H, Nisbet C, and Gushulak B Vitamin D insufficiency and bone mineral status in a population of newcomer children in Canada Nutrients. 2013 5 5 1561 -72
El Hayek J, Pham TT, Finch S, et al. Vitamin D status in Montreal preschoolers is satisfactory despite low vitamin D intake J Nutr. 2013 143 2 154 -60
Hiza HA, Casavale KO, Guenther PM, and Davis CA Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level J Acad Nutr Diet. 2013 113 2 297 -306
Rajani S, Sawyer-Bennett J, Shirton L, DeHaan G, Kluthe C, Persad R, et al. Patient and parent satisfaction with a dietitian- and nurse- led celiac disease clinic for children at the Stollery Children's Hospital, Edmonton, Alberta Can J Gastroenterol. 2013 27 8 463 -6

Information & Authors


Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 76Number 2June 2015
Pages: 56 - 63


Version of record online: 17 February 2015



Abeer S. Alzaben MSc
Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB
Justine Turner MD, FRCPC
Department of Pediatrics, University of Alberta, Edmonton, AB
Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
Leanne Shirton RN
Department of Pediatrics, University of Alberta, Edmonton, AB
Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
Tarah M. Samuel MN, NP
Department of Pediatrics, University of Alberta, Edmonton, AB
Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
Rabin Persad MD, FRCPC
Department of Pediatrics, University of Alberta, Edmonton, AB
Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
Diana Mager PhD, RD
Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB
Department of Pediatrics, University of Alberta, Edmonton, AB

Metrics & Citations


Other Metrics


Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

Cited by

1. Food Environment and Youth Intake May Influence Uptake of Gluten-Free Food Guide Recommendations in Celiac Disease
2. Dietary Intake and Micronutrient Supplementation in Youth with Celiac Disease with and without Type 1 Diabetes
3. Vitamin D Status and Bone Mineral Density is Influenced by Vitamin D Supplementation and Vitamin K1 Intake in Adults with Diabetes and Chronic Kidney Disease
4. Parental Health Beliefs, Socio-demographics, and Healthcare Recommendations Influence Micronutrient Supplementation in Youth with Celiac Disease

View Options

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.


Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options


View PDF

Full Text

View Full Text





Share Options


Share the article link

Share on social media