Mediterranean Diet Adherence in Celiac Patients: A Nested Cross-Sectional Study

Abstract

Background/Objectives: The Mediterranean diet (MD) reduces cardiovascular risk, which is higher in celiac disease (CD). We aimed to investigate adherence to the MD in newly diagnosed CD patients, CD patients on a gluten-free diet (GFD), and in a non-celiac control group. Additionally, we aimed to establish an association between GFD and MD adherence. Methods: In this nested, cross-sectional Hungarian study, MD adherence was assessed using the Mediterranean Diet Score (MDS), and GFD adherence was assessed using the Standardized Dietitian Evaluation (SDE). Results: A total of 215 subjects were enrolled, 128 of which were CD patients on a GFD for a minimum of 1 year, 24 were newly diagnosed CD patients, and 63 were non-CD healthy control subjects. Although the control subjects had a higher mean MDS, the groups did not differ statistically significantly from each other (CD on GFD: 5.55 ± 1.57, newly diagnosed CD: 5.35 ± 1.81, controls: 6.05 ± 1.73; p > 0.05)—all groups had suboptimal scores. Both CD groups consumed fewer whole grains than the controls (p < 0.001). Adequate GFD adherence was associated with higher MDS (5.62 ± 1.54 vs. 4.71 ± 1.21, respectively; p = 0.009). Conclusions: Our study highlights the low adherence to MD in celiac patients with insufficient consumption of whole grains. Adherence to GFD is associated with better MD adherence, which underlines the role of dietary education during follow-up. Targeted nutritional counseling could improve the quality of diet in CD patients to reduce cardiovascular risk.