{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T22:20:46Z","timestamp":1781130046194,"version":"3.54.1"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2018,8,25]],"date-time":"2018-08-25T00:00:00Z","timestamp":1535155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>(1) Background: Celiac disease (CD) is a common autoimmune disorder. The manifestations of the disease and the obligatory life-long gluten-free diet (GFD) are associated with the impairment of patients\u2019 quality of life. Therefore, the present study aimed to translate, culturally adapt and validate a celiac disease quality of life (CD-QoL) questionnaire and apply it to a representative number of Brazilian CD patients. (2) Methods: A cross-cultural Brazilian-Portuguese version of the CD-QoL was developed according to revised international guidelines. The questionnaire was administered to 450 celiac patients. The reliability, reproducibility and validity were studied. (3) Results: The Brazilian CD-QoL questionnaire presents valid measures of reproducibility and internal consistency. Early diagnosis is related to higher scores of Brazilian CD-QoL social, sub- and total scale. There was a positive correlation between higher education level and higher QoL. Individuals with partners tend to have a better emotional subscale of QoL. CD-patients who follow a strict GFD have highest QoL scale values. Men scored higher than women on the CD-QoL. All results were statistically significant except for the gastrointestinal subscale. (4) Conclusions: Brazilian CD-QoL allows comparative research between different celiac populations in the world. QoL research will help in the development of effective strategies to improve Brazilian celiac patients\u2019 quality of life.<\/jats:p>","DOI":"10.3390\/nu10091167","type":"journal-article","created":{"date-parts":[[2018,8,27]],"date-time":"2018-08-27T10:56:04Z","timestamp":1535367364000},"page":"1167","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Quality of Life of Celiac Patients in Brazil: Questionnaire Translation, Cultural Adaptation and Validation"],"prefix":"10.3390","volume":"10","author":[{"given":"Claudia","family":"Pratesi","sequence":"first","affiliation":[{"name":"Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, 70910-900 Brasilia, DF, Brazil"},{"name":"Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3742-729X","authenticated-orcid":false,"given":"Winfred","family":"H\u00e4user","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Klinikum Saarbr\u00fccken and Department of Psychosomatic Medicine and Psychotherapy, Technische Universit\u00e4t M\u00fcnchen, 80333 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Uenishi","sequence":"additional","affiliation":[{"name":"Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, 70910-900 Brasilia, DF, Brazil"},{"name":"Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Selleski","sequence":"additional","affiliation":[{"name":"Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, 70910-900 Brasilia, DF, Brazil"},{"name":"Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9071-8512","authenticated-orcid":false,"given":"Eduardo","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Brasilia, 70910-900 Brasilia, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenora","family":"Gandolfi","sequence":"additional","affiliation":[{"name":"Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, 70910-900 Brasilia, DF, Brazil"},{"name":"Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Pratesi","sequence":"additional","affiliation":[{"name":"Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, 70910-900 Brasilia, DF, Brazil"},{"name":"Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0370-3089","authenticated-orcid":false,"given":"Renata","family":"Zandonadi","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Health Sciences, University of Brasilia, 70910-900 Brasilia, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/MPG.0000000000000410","article-title":"Celiac Disease","volume":"59","author":"Shamir","year":"2014","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1053\/j.gastro.2009.09.008","article-title":"Celiac Disease: From Pathogenesis to Novel Therapies","volume":"137","author":"Schuppan","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/j.giec.2012.07.002","article-title":"Celiac Disease in the Developing World","volume":"22","author":"Barada","year":"2012","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.yapd.2008.07.001","article-title":"Celiac disease: Pathophysiology, clinical manifestations and associated autoimmune conditions","volume":"55","author":"Barker","year":"2008","journal-title":"Adv. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1038\/nrgastro.2013.141","article-title":"Advances in the treatment of coeliac disease: An immunopathogenic perspective","volume":"11","author":"Kaukinen","year":"2014","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.dld.2012.10.018","article-title":"The Italian translation of the Celiac Disease-specific Quality of Life Scale in celiac patients on gluten free diet","volume":"45","author":"Zingone","year":"2013","journal-title":"Dig. Liver Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/01.meg.0000221855.19201.e8","article-title":"Health-related quality of life in adult coeliac disease in Germany: Results of a national survey","volume":"18","author":"Gold","year":"2006","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ejim.2012.09.015","article-title":"Quality of life in coeliac patients: Italian validation of a coeliac questionnaire","volume":"24","author":"Marchese","year":"2013","journal-title":"Eur. J. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12955-015-0272-y","article-title":"Validation of the Turkish version of the Celiac Disease Questionnaire (CDQ)","volume":"13","author":"Aksan","year":"2015","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pouchot, J., Despujol, C., Malamut, G., Ecosse, E., Coste, J., and Cellier, C. (2014). Validation of a French version of the quality of life \u201cCeliac Disease Questionnaire\u201d. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0096346"},{"key":"ref_11","first-page":"46","article-title":"Gluten-free dietary compliance in Brazilian celiac patients: Questionnaire versus serological test","volume":"33","author":"Machado","year":"2013","journal-title":"Nutr. Clin. Diet. Hosp."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Farage, P., Puppin Zandonadi, R., Cortez Ginani, V., Gandolfi, L., Pratesi, R., and de Medeiros N\u00f3brega, Y.K. (2017). Content Validation and Semantic Evaluation of a Check-List Elaborated for the Prevention of Gluten Cross-Contamination in Food Services. Nutrients, 9.","DOI":"10.3390\/nu9010036"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1365-277X.2005.00591.x","article-title":"\u2018Controlled by food\u2019\u2014Lived experiences of coeliac disease","volume":"18","author":"Sverker","year":"2005","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0895-4356(98)00082-1","article-title":"Translating health status questionnaires and evaluating their quality: The IQOLA Project approach. International Quality of Life Assessment","volume":"51","author":"Bullinger","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.im.2003.11.002","article-title":"The Delphi method as a research tool: An example, design considerations and applications","volume":"42","author":"Okoli","year":"2004","journal-title":"Inf. Manag."},{"key":"ref_16","first-page":"4","article-title":"Content validation of an instrument to characterize people over 50 years of age living with human immunodeficiency virus\/acquired immunodeficiency syndrome","volume":"25","author":"Gallani","year":"2012","journal-title":"Acta Paul. Enferm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1590\/S0102-311X2010000300008","article-title":"Cross-cultural adaptation: Translation and Portuguese language content validation of the Tripartite Influence Scale for body dissatisfaction","volume":"26","author":"Conti","year":"2010","journal-title":"Cad. Saude Publ."},{"key":"ref_18","unstructured":"Polit, D.F., and Beck, C.T. (2004). Nursing Research: Principles and Methods, Lippincott Williams & Wilkins."},{"key":"ref_19","unstructured":"Kline, R.B. (2011). Principles and Practice of Structural Equation Modeling, The Guilford Press. [3rd ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indices in covariance structure analysis: Conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct. Equ. Model."},{"key":"ref_21","unstructured":"World Health Organization (2008). The Third Ten Years of the World Health Organization, WHO. [1st ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/scs.12050","article-title":"Translation and validation of the wound-specific quality of life instrument Cardiff Wound Impact Schedule in a Swedish population","volume":"28","author":"Fagerdahl","year":"2014","journal-title":"Scand. J. Caring Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1023\/A:1013867826835","article-title":"The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research","volume":"10","author":"Saxena","year":"2001","journal-title":"Qual. Life Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/0895-4356(93)90142-N","article-title":"Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines","volume":"46","author":"Guillemin","year":"1993","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3186","DOI":"10.1097\/00007632-200012150-00014","article-title":"Guidelines for the process of cross-cultural adaptation of self-report measures","volume":"25","author":"Beaton","year":"2000","journal-title":"Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1207\/S15327752JPA8001_18","article-title":"Starting at the Beginning: An Introduction to Coefficient Alpha and Internal Consistency Starting at the Beginning: An Introduction to Coefficient Alpha and Internal Consistency","volume":"80","author":"Streiner","year":"2003","journal-title":"J. Pers. Assess."},{"key":"ref_27","unstructured":"Streiner, D.L., and Norman, G.R. (2008). Health Measurement Scales: A Practical Guide to Their Development and Use, Oxford University Press."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/S0140-6736(96)70237-4","article-title":"Coeliac disease","volume":"349","author":"Collin","year":"1997","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/0013916596283003","article-title":"Gender and Environmental Risk Concerns","volume":"28","author":"Davidson","year":"1996","journal-title":"Environ. Behav."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1108\/00070701311317829","article-title":"Consumers\u2019 health and taste attitude in Taiwan","volume":"115","author":"Chen","year":"2013","journal-title":"Br. Food J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/jhn.12319","article-title":"Coeliac disease: The association between quality of life and social support network participation","volume":"29","author":"Lee","year":"2016","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1590\/S0004-28032015000300003","article-title":"Quality of life evaluation in celiac patients from Southern Brazil","volume":"52","author":"Castilhos","year":"2015","journal-title":"Arq. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ram\u00edrez-Cervantes, K.L., Remes-Troche, J.M., del Pilar Milke-Garc\u00eda, M., Romero, V., and Uscanga, L.F. (2015). Characteristics and factors related to quality of life in Mexican Mestizo patients with celiac disease. BMC Gastroenterol., 15.","DOI":"10.1186\/s12876-015-0229-y"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/003655202753387338","article-title":"Living with coeliac disease: Controlled study of the burden of illness","volume":"37","author":"Hallert","year":"2002","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1046\/j.1471-6712.2003.00228.x","article-title":"Perceptions of health-related quality of life of men and women living with coeliac disease","volume":"17","author":"Hallert","year":"2003","journal-title":"Scand. J. Caring Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1365-277X.2006.00659.x","article-title":"The impact of a gluten-free diet on adults with coeliac disease: Results of a national survey","volume":"19","author":"Zarkadas","year":"2006","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.jpeds.2010.08.034","article-title":"Compliance with the Gluten-Free Diet: The Role of Locus of Control in Celiac Disease","volume":"158","author":"Bellini","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1097\/MPG.0b013e31817fcb56","article-title":"Quality of Life in Adolescents with Treated Coeliac Disease: Influence of Compliance and Age at Diagnosis","volume":"47","author":"Wagner","year":"2008","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/j.1365-277X.2009.01036.x","article-title":"Dietary compliance and life style of children with coeliac disease","volume":"23","author":"Roma","year":"2010","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1111\/j.1365-2036.2006.03227.x","article-title":"Predictors of reduced health-related quality of life in adults with coeliac disease","volume":"25","author":"Stallmach","year":"2007","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/SGA.0b013e318255fe3a","article-title":"Impact of an Active Patient Education Program on Gastrointestinal Symptoms in Women With Celiac Disease Following a Gluten-Free Diet","volume":"35","author":"Jacobsson","year":"2012","journal-title":"Gastroenterol. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/jhn.12009","article-title":"Coeliac disease: The path to diagnosis and the reality of living with the disease","volume":"26","author":"Taylor","year":"2013","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0738-3991(02)00239-2","article-title":"Health literacy and knowledge of chronic disease","volume":"51","author":"Gazmararian","year":"2003","journal-title":"Patient Educ. Couns."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0022-3999(02)00303-3","article-title":"Epidemiologic evidence for the relation between socioeconomic status and depression, obesity and diabetes","volume":"53","author":"Everson","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.cpr.2015.03.001","article-title":"Healthcare interventions for depression in low socioeconomic status populations: A systematic review and meta-analysis","volume":"38","year":"2015","journal-title":"Clin. Psychol. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.socscimed.2011.12.017","article-title":"Socioeconomic status and the development of depressive symptoms from childhood to adulthood: A longitudinal analysis across 27 years of follow-up in the Young Finns study","volume":"74","author":"Elovainio","year":"2012","journal-title":"Soc. Sci. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S-438","DOI":"10.1016\/S0016-5085(11)61796-4","article-title":"Socioeconomic Status Influences Celiac Disease Diagnosis","volume":"140","author":"Mehra","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_48","unstructured":"IBGE (2018, June 03). Pesquisas de Or\u00e7amentos Familiares, Available online: https:\/\/biblioteca.ibge.gov.br\/visualizacao\/livros\/liv50063.pdf."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/9\/1167\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:21:04Z","timestamp":1760196064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/9\/1167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,25]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2018,9]]}},"alternative-id":["nu10091167"],"URL":"https:\/\/doi.org\/10.3390\/nu10091167","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,25]]}}}