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The only effective treatment is a gluten-free diet (GFD), but adherence can be challenging. This study investigates GFD adherence among CeD patients and the change in their clinical and pathological conditions over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A telephone-based retrospective observational analysis conducted between November 2022 and June 2023 enrolled 300 participants with confirmed CeD, selected via systematic sampling from an initial cohort of 1,268 individuals. A comprehensive questionnaire assessed demographics, clinical symptoms, and GFD adherence. Participants were categorized into short\/meidum-term (\u2264\u20096 months), long-term (6\u201324 months), and very long-term (\u2265\u200924 months) GFD adherence groups. All statistical analyses were conducted using R (version 4.3.1), employing a variety of packages tailored for descriptive and inferential statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants\u2019 mean age was 41.58 (\u00b1\u200912.37) years, with females constituting 73.67% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009221\/300). GFD adherence was assessed, revealing that 55.33% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009166\/300) of patients adhered strictly to the diet, while 28.33% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200985\/300) experienced worsening adherence over time (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Significant improvements were observed in GI and non-GI symptoms across disease duration, with abdominal pain absence increasing from 71.2 to 84.9% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), and depression absence improving from 63.6 to 89.6% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Additionally, laboratory values such as VitD and HCT showed improvement (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), while the comorbidity burden decreased significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Enhanced patient support, including dietary and mental health resources, is vital for improving outcomes in CeD patients. Further research should explore barriers to adherence and the psychosocial effects of living with CeD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-025-04193-3","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T09:14:14Z","timestamp":1755508454000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Gluten-free diet adherence patterns and health outcomes in celiac disease: a retrospective observational study"],"prefix":"10.1186","volume":"25","author":[{"given":"Saba","family":"Rahimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohadeseh","family":"Mahmoudi Ghehsareh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nastaran","family":"Asri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Azizmohammad Looha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somayeh","family":"Jahani-Sherafat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Ciacci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2495-1831","authenticated-orcid":false,"given":"Mohammad","family":"Rostami-Nejad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"issue":"5","key":"4193_CR1","first-page":"501","volume":"66","author":"R Francavilla","year":"2014","unstructured":"Francavilla R, Cristofori F, Stella M, Borrelli G, Naspi G, Castellaneta S. 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