{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:52:51Z","timestamp":1792637571997,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,3,21]],"date-time":"2020-03-21T00:00:00Z","timestamp":1584748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002878","name":"Consejer\u00eda de Econom\u00eda, Innovaci\u00f3n, Ciencia y Empleo, Junta de Andaluc\u00eda","doi-asserted-by":"publisher","award":["P12-AGR-2581"],"award-info":[{"award-number":["P12-AGR-2581"]}],"id":[{"id":"10.13039\/501100002878","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006393","name":"Universidad de Granada","doi-asserted-by":"publisher","award":["(PPIT)2016"],"award-info":[{"award-number":["(PPIT)2016"]}],"id":[{"id":"10.13039\/501100006393","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003176","name":"Ministerio de Educaci\u00f3n, Cultura y Deporte","doi-asserted-by":"publisher","award":["FPU17\/03715"],"award-info":[{"award-number":["FPU17\/03715"]}],"id":[{"id":"10.13039\/501100003176","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The current study assesses whether the use of a gluten-free diet (GFD) is sufficient for maintaining correct iron status in children with celiac disease (CD). The study included 101 children. The celiac group (n = 68) included children with CD, with long (&gt; 6 months) (n = 47) or recent (&lt; 6 months) (n = 21) adherence to a GFD. The control group (n = 43) included healthy children. Dietary assessment was performed by a food frequency questionnaire and a 3-day food record. Celiac children had lower iron intake than controls, especially at the beginning of GFD (p &lt; 0.01). The group CD-GFD &gt;6 months showed a higher intake of cobalamin, meat derivatives and fish compared to that of CD-GFD &lt;6 months (all, p &lt; 0.05). The control group showed a higher consumption of folate, iron, magnesium, selenium and meat derivatives than that of children CD-GFD &gt;6 months (all, p &lt; 0.05). Control children also showed a higher consumption of folate and iron compared to that of children CD-GFD &lt;6 months (both, p &lt; 0.05). The diet of celiac children was nutritionally less balanced than that of the control. Participation of dietitians is necessary in the management of CD to guide the GFD as well as assess the inclusion of iron supplementation and other micronutrients that may be deficient.<\/jats:p>","DOI":"10.3390\/nu12030844","type":"journal-article","created":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T04:03:01Z","timestamp":1584936181000},"page":"844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Is a Gluten-Free Diet Enough to Maintain Correct Micronutrients Status in Young Patients with Celiac Disease?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9573-3244","authenticated-orcid":false,"given":"Teresa","family":"Nestares","sequence":"first","affiliation":[{"name":"Department of Physiology and \u201cJos\u00e9 MataixVerd\u00fa\u201d Institute of Nutrition and Food Technology (INYTA), University of Granada, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0113-9904","authenticated-orcid":false,"given":"Rafael","family":"Mart\u00edn-Masot","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Malaga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Labella","sequence":"additional","affiliation":[{"name":"Pediatric Clinical Management Unit., \u201cSan Cecilio\u201d University Hospital, 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2867-378X","authenticated-orcid":false,"given":"Virginia A.","family":"Aparicio","sequence":"additional","affiliation":[{"name":"Department of Physiology and \u201cJos\u00e9 MataixVerd\u00fa\u201d Institute of Nutrition and Food Technology (INYTA), University of Granada, 18071 Granada, Spain"},{"name":"Sport and Health University Research Institute (iMUDS), 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8256-5053","authenticated-orcid":false,"given":"Marta","family":"Flor-Alemany","sequence":"additional","affiliation":[{"name":"Department of Physiology and \u201cJos\u00e9 MataixVerd\u00fa\u201d Institute of Nutrition and Food Technology (INYTA), University of Granada, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"L\u00f3pez-Fr\u00edas","sequence":"additional","affiliation":[{"name":"Department of Physiology and \u201cJos\u00e9 MataixVerd\u00fa\u201d Institute of Nutrition and Food Technology (INYTA), University of Granada, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Granada, 18071 Granada, Spain"},{"name":"Biosanitary Research Institute, 18071 Granada, Spain"},{"name":"Maternal and Child Health Network, Carlos III Health Institute, 28029 Madrid, Spain"},{"name":"Pediatric Clinical Management Unit. \u201cVirgen de las Nieves\u201d University Hospital, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1053\/j.gastro.2016.11.043","article-title":"Prevalence and Morbidity of Undiagnosed CD Froma Community-Based Study","volume":"152","author":"Choung","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1038\/ajg.2012.219","article-title":"The Prevalence of CDin the United States","volume":"107","author":"Ludvigsson","year":"2012","journal-title":"Am. J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1053\/j.gastro.2018.04.016","article-title":"Prevalence of CDin Patients with Iron Deficiency Anemia\u2014A Systematic Review With Meta-analysis","volume":"155","author":"Mahadev","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_4","first-page":"691","article-title":"The clinical pattern of subclinical\/silent celiac disease: An analysis on 1026 consecutive cases 1","volume":"94","author":"Bottaro","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Martin-Masot, R., Nestares, M.T., Diaz-Castro, J., L\u00f3pez-Aliaga, I., Mu\u00f1oz Alf\u00e9rez, M.J., Moreno-Fern\u00e1ndez, J., and Maldonado, J. (2019). Multifactorial Etiology of Anemia in CDand Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients, 11.","DOI":"10.3390\/nu11112557"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/ajcn\/79.4.669","article-title":"Effect of a GFD on gastrointestinal symptoms in celiac disease","volume":"79","author":"Murray","year":"2004","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.cgh.2006.12.006","article-title":"Etiologies and Predictors of Diagnosis in Nonresponsive Celiac Disease","volume":"5","author":"Leffler","year":"2007","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4553","DOI":"10.3390\/nu5114553","article-title":"GFD in children: An approach to a nutritionally adequate and balanced diet","volume":"5","author":"Penagini","year":"2013","journal-title":"Nutrients"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/S0002-8223(00)00386-2","article-title":"Folate, Iron, and Dietary Fiber Contents of the Gluten-free Diet","volume":"100","author":"Thompson","year":"2000","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/S0002-8223(99)00205-9","article-title":"Thiamin, riboflavin, and niacin contents of the gluten-free diet: Is there cause for concern?","volume":"99","author":"Thompson","year":"1999","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1046\/j.1365-2036.2002.01283.x","article-title":"Evidence of poor vitamin status in coeliac patients on a GFDfor 10 years","volume":"16","author":"Hallert","year":"2002","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4617","DOI":"10.3748\/wjg.15.4617","article-title":"An update on iron physiology","volume":"15","author":"Villar","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0065-3101(23)00084-1","article-title":"Iron deficiency anemia","volume":"48","author":"Leung","year":"2001","journal-title":"Adv. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/MPG.0000000000001234","article-title":"Anemia and iron deficiency in children with potential celiac disease","volume":"64","author":"Repo","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1002\/ajh.20996","article-title":"Anemia in CD is multifactorial in etiology","volume":"82","author":"Harper","year":"2007","journal-title":"Am. J. Hematol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/j.1651-2227.2005.tb01964.x","article-title":"The prevalence of coeliac disease as detected by screening in children with iron deficiency anaemia","volume":"94","author":"Kalayci","year":"2005","journal-title":"Acta Paediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"9233","DOI":"10.3748\/wjg.v21.i31.9233","article-title":"Iron deficiency anemia in celiac disease","volume":"21","author":"Freeman","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1572-0241.2001.03463.x","article-title":"Efficacy of GFDalone on recovery from iron deficiency anemia in adult celiac patients","volume":"96","author":"Annibale","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/MPG.0b013e31821a23d0","article-title":"European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease","volume":"54","author":"Husby","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1136\/bmj.320.7244.1240","article-title":"Establishing a standard definition for child overweight and obesity worldwide: International survey","volume":"320","author":"Cole","year":"2000","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1007\/BF02723818","article-title":"Iron Supplementation in Children with Celiac Disease","volume":"70","author":"Kapur","year":"2003","journal-title":"Indian J. Pediatr."},{"key":"ref_22","unstructured":"Mataix, J.L., Martinez de Victoria, E., Montellano, M.A., Lopez, M., and Aranda, P.L. (2000). Valoraci\u00f3n del Estado Nutricional de la ComunidadAut\u00f3noma de Andaluc\u00eda, Consejer\u00eda de Salud de la Junta de Andaluc\u00eda."},{"key":"ref_23","unstructured":"Ruiz, M.D., and Artacho, R. (2011). Gu\u00eda Para EstudiosDiet\u00e9ticos: \u00c1lbumFotogr\u00e1fico de Alimentos, Universidad de Granada."},{"key":"ref_24","unstructured":"Moreiras, O., Carbajal, A., Cabrera, L., and Cuadrado, C. (2016). Ingestasdiariasrecomendadas de energ\u00eda y nutrientespara la poblaci\u00f3nespa\u00f1ola. Tablas de Composici\u00f3n de Alimentos, Ediciones Pir\u00e1mide. [18th ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"King, J.A., Jeong, J., Underwood, F.E., Quan, J., Panaccione, N., Windsor, J.W., Coward, S., de Bruyn, J., Ronksley, P.E., and Shaheen, A.A. (2020). Incidence of Celiac Disease Is Increasing Over Time: A Systematic Review and Meta-analysis. Am. J. Gastroenterol.","DOI":"10.14309\/ajg.0000000000000523"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lionetti, E., Antonucci, N., Marinelli, M., Bartolomei, B., Franceschini, E., Gatti, S., Catassi, G.N., Verma, A.K., Monachesi, C., and Catassi, C. (2020). Nutritional status, dietary intake, and adherence to the mediterranean diet of children with CD on a gluten-free diet: A case-control prospective study. Nutrients, 12.","DOI":"10.3390\/nu12010143"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/MPG.0000000000001221","article-title":"Anemia in pediatric celiac disease: Association with clinical and histoogical features and response to gluten-free diet","volume":"64","author":"Rajalahti","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Di Nardo, G., Villa, M.P., Conti, L., Ranucci, G., Pacchiarotti, C., Principessa, L., Rauci, U., and Parisei, P. (2019). Nutritional deficiencies in children with celiac disease resulting from a gluten-free diet: A systematic review. Nutrients, 11.","DOI":"10.3390\/nu11071588"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Melini, V., and Melini, F. (2019). Gluten-free diet: Gaps and needs for a healthier diet. Nutrients, 11.","DOI":"10.3390\/nu11010170"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/jhn.12125","article-title":"Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries","volume":"27","author":"Kautto","year":"2014","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_31","first-page":"374","article-title":"Is compliance with GFDsufficient? Diet composition of celiac patients","volume":"57","author":"Balamtekin","year":"2015","journal-title":"Turk. J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3148\/cjdpr-2014-040","article-title":"Assessing Nutritional Quality and Adherence to the GFDin Children and Adolescents with Celiac Disease","volume":"76","author":"Alzaben","year":"2015","journal-title":"Can. J. Diet. Pract. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/MPG.0000000000001251","article-title":"Patients With Celiac Disease Reported Higher Consumption of Added Sugar and Total Fat Than Healthy Individuals","volume":"64","author":"Babio","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s11130-014-0410-4","article-title":"Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten","volume":"69","author":"Miranda","year":"2014","journal-title":"Plant Foods Hum. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11894-018-0606-0","article-title":"Paediatric Patients with Coeliac Disease on a Gluten-Free Diet: Nutritional Adequacy and Macro- and Micronutrient Imbalances","volume":"20","author":"Sue","year":"2018","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s11357-018-0024-0","article-title":"Maternal nutrient restriction in baboon programs later-life cellular growth and respiration of cultured skin fibroblasts: A potential model for the study of aging-programming interactions","volume":"40","author":"Salmon","year":"2018","journal-title":"GeroScience"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Diaz-Castro, J., Muriel-Neyra, C., Martin-Masot, R., Moreno-Fernandez, J., Maldonado, J., and Nestares, T. (2019). Oxidative stress, DNA stability and evoked inflammatory signaling in young celiac patients consuming a gluten-free diet. Eur. J. Nutr.","DOI":"10.1007\/s00394-019-02013-5"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1136\/gut.37.6.766","article-title":"Gluten specific, HLA-DQ restricted T cells from coeliac mucosa produce cytokines with Th1 or Th0 profile dominated by interferon gamma","volume":"37","author":"Nilsen","year":"1995","journal-title":"Gut"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/nature01322","article-title":"Inflammation and cancer","volume":"420","author":"Coussens","year":"2002","journal-title":"Nature"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1159\/000348850","article-title":"Inadequate nutrient intake in patient with celiac disease. Results from a German dietary survey","volume":"87","author":"Martin","year":"2013","journal-title":"Digestion"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"BallesteroFern\u00e1ndez, C., Varela-Moreiras, G., \u00dabeda, N., and Alonso-Aperte, E. (2019). Nutritional status in spanish children and adolescents with celiac disease on a gluten free diet compared to non-celiac disease controls. Nutrients, 11.","DOI":"10.3390\/nu11102329"},{"key":"ref_42","first-page":"1","article-title":"The effect of self-efficacy expectations in the adherence to a gluten free diet in celiac disease","volume":"13","year":"2019","journal-title":"Psychol. Health."},{"key":"ref_43","unstructured":"Grupo de trabajo del Protocolopara el diagn\u00f3sticoprecoz de la enfermedadcel\u00edaca (2018). Protocolo Para el Diagn\u00f3sticoPrecoz de la EnfermedadCel\u00edaca."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"449","DOI":"10.12968\/bjon.2016.25.8.449","article-title":"The role of nurses and dietitians in managing paediatric coeliac disease","volume":"25","author":"Fok","year":"2016","journal-title":"Br. J. Nurs."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/3\/844\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:10:21Z","timestamp":1760173821000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/3\/844"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,21]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["nu12030844"],"URL":"https:\/\/doi.org\/10.3390\/nu12030844","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,21]]}}}