{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:39Z","timestamp":1789711779937,"version":"4.0.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective longitudinal cohort study with a cross-sectional survey component included 81 pediatric patients with CD (67.9% female; mean age 14.9\u2009\u00b1\u20093.4 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At the beginning of the pandemic in March 2020, the mean duration of GFD was 3.9\u2009\u00b1\u20092.4 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\u2009=\u200931.818,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Compared with the pre-pandemic period (51.9%, 42\/81), serological adherence was significantly higher during both the restriction period (82.7%, 67\/81) and the post-pandemic period (76.5%, 62\/81) (McNemar\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001 for both comparisons), whereas no significant difference was observed between the restriction and post-pandemic periods (McNemar\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.227). Serological adherence was associated with home-cooking and selected family and socioeconomic factors. Most participants (87.7%) reported difficulty accessing gluten-free products, mainly due to high cost and limited variety. No significant differences were observed in anthropometric measurements across the study periods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1923034","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:39:32Z","timestamp":1789709972000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in gluten-free diet adherence and growth parameters among children with celiac disease during the COVID-19 pandemic"],"prefix":"10.3389","volume":"14","author":[{"given":"Ya\u011fmur","family":"Erkol Y\u0131lmaz","sequence":"first","affiliation":[{"name":"Department of Pediatrics, School of Medicine, Ankara University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceyda","family":"Tuna K\u0131rsa\u00e7l\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Ankara University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aydan","family":"Kansu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Ankara University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arzu","family":"Ensari","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Ankara University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zarife","family":"Kulo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Ankara University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12941-021-00438-7","article-title":"COVID-19: breaking down a global health crisis","volume":"20","author":"Mallah","year":"2021","journal-title":"Ann Clin Microbiol 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