{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:50:25Z","timestamp":1792457425233,"version":"4.5.0"},"reference-count":129,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Economy, Knowledge, Business and University (project AT17_5489_USE) PAIDI 2020: Knowledge Transfer Ac-tivities and Fundaci\u00f3n Progreso y Salud, Consejer\u00eda de Salud, Junta de Andaluc\u00eda (project PI-0053-2018).","award":["AT17_5489_USE; PI-0053-2018"],"award-info":[{"award-number":["AT17_5489_USE; PI-0053-2018"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Celiac disease (CD) is a chronic gluten-responsive immune mediated enteropathy and is treated with a gluten-free diet (GFD). However, a strict diet for life is not easy due to the ubiquitous nature of gluten. This review aims at examining available evidence on the degree of adherence to a GFD, the methods to assess it, and the barriers to its implementation. The methods for monitoring the adherence to a GFD are comprised of a dietary questionnaire, celiac serology, or clinical symptoms; however, none of these methods generate either a direct or an accurate measure of dietary adherence. A promising advancement is the development of tests that measure gluten immunogenic peptides in stools and urine. Causes of adherence\/non-adherence to a GFD are numerous and multifactorial. Inadvertent dietary non-adherence is more frequent than intentional non-adherence. Cross-contamination of gluten-free products with gluten is a major cause of inadvertent non-adherence, while the limited availability, high costs, and poor quality of certified gluten-free products are responsible for intentionally breaking a GFD. Therefore, several studies in the last decade have indicated that many patients with CD who follow a GFD still have difficulty controlling their diet and, therefore, regularly consume enough gluten to trigger symptoms and damage the small intestine.<\/jats:p>","DOI":"10.3390\/nu13072274","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T10:03:19Z","timestamp":1625047399000},"page":"2274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":103,"title":["Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease"],"prefix":"10.3390","volume":"13","author":[{"given":"Herbert","family":"Wieser","sequence":"first","affiliation":[{"name":"Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7100-846X","authenticated-orcid":false,"given":"\u00c1ngela","family":"Ruiz-Carnicer","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9600-8979","authenticated-orcid":false,"given":"Ver\u00f3nica","family":"Segura","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4982-273X","authenticated-orcid":false,"given":"Isabel","family":"Comino","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Caio, G., Volta, U., Sapone, A., Leffler, D.A., De Giorgio, R., Catassi, C., and Fasano, A. 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