{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:26:16Z","timestamp":1791570376630,"version":"4.3.4"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"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>Evidence on the consumption of ultra-processed foods (UPF) in adults with celiac disease (CD) and its impact on Mediterranean Diet (MD) adherence is still limited. Our aim was to determine UPF consumption and its relationship with MD adherence in a group of adults, according to the presence of CD. This case-control study included 103 adults with CD and 312 without CD. UPF intake was assessed using the NOVA Food Frequency Questionnaire (NFFQ), while MD adherence was assessed using the Medi-Lite score. UPF represented 14.5% of the diet of participants with CD (246 g\/day) and came mainly from cereals-based products (29%) and sweets (24.2%). UPF consumption did not differ with the presence of CD, but participants with CD had significantly (p &lt; 0.05) higher consumption of precooked pasta and pre-packaged breads. Participants with CD also reported a significantly lower MD adherence than participants without CD (9.4 vs. 10.4), with higher intake of meat and dairy products, and lower consumption of vegetables and fish. An inverse trend was found between UPF consumption and MD adherence in adults with CD, although not statistically significant. These findings highlight the importance of improving nutrition education for subjects with CD, which should not only focus on gluten exclusion.<\/jats:p>","DOI":"10.3390\/nu15040938","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T03:09:32Z","timestamp":1676344172000},"page":"938","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Adherence to the Mediterranean Diet and Ultra-Processed Foods Consumption in a Group of Italian Patients with Celiac Disease"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8163-1469","authenticated-orcid":false,"given":"Marta","family":"Tristan Asensi","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2177-2857","authenticated-orcid":false,"given":"Giuditta","family":"Pagliai","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9288-5683","authenticated-orcid":false,"given":"Sofia","family":"Lotti","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5674-2578","authenticated-orcid":false,"given":"Abigail","family":"Corrao","sequence":"additional","affiliation":[{"name":"Department of Human Science, Georgetown University, Washington, DC 20057, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1397-9791","authenticated-orcid":false,"given":"Barbara","family":"Colombini","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9230-595X","authenticated-orcid":false,"given":"Ilaria","family":"Giangrandi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"},{"name":"Unit of Clinical Nutrition, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7113-7424","authenticated-orcid":false,"given":"Francesco","family":"Sofi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"},{"name":"Unit of Clinical Nutrition, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1687-2527","authenticated-orcid":false,"given":"Monica","family":"Dinu","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1177\/2050640619844125","article-title":"European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders","volume":"7","author":"Volta","year":"2019","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis","volume":"16","author":"Singh","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1136\/gutjnl-2013-306578","article-title":"Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology","volume":"63","author":"Ludvigsson","year":"2014","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cardo, A., Churruca, I., Lasa, A., Navarro, V., V\u00e1zquez-Polo, M., Perez-Junkera, G., and Larretxi, I. (2021). Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet. Nutrients, 13.","DOI":"10.3390\/nu13082877"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/jhn.12502","article-title":"An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK","volume":"31","author":"Fry","year":"2018","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s00394-018-1685-2","article-title":"Gluten-free-rendered products contribute to imbalanced diets in children and adolescents with celiac disease","volume":"58","author":"Larretxi","year":"2019","journal-title":"Eur. J. Nutr."},{"key":"ref_7","first-page":"814","article-title":"A comparison of the nutritional profile and price of gluten-free products and their gluten-containing counterparts available in the Spanish market","volume":"37","author":"Babio","year":"2020","journal-title":"Nutr. Hosp."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1017\/S1368980018003762","article-title":"Ultra-processed foods: What they are and how to identify them","volume":"22","author":"Monteiro","year":"2019","journal-title":"Public Health Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e009892","DOI":"10.1136\/bmjopen-2015-009892","article-title":"Ultra-processed foods and added sugars in the US diet: Evidence from a nationally representative cross-sectional study","volume":"6","author":"Baraldi","year":"2016","journal-title":"BMJ Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1016\/j.numecd.2022.08.018","article-title":"Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries","volume":"32","author":"Steele","year":"2022","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1017\/S1368980017001677","article-title":"Quantifying associations of the dietary share of ultra-processed foods with overall diet quality in First Nations peoples in the Canadian provinces of British Columbia, Alberta, Manitoba and Ontario","volume":"21","author":"Batal","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.numecd.2018.06.021","article-title":"Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet?","volume":"28","author":"Morreale","year":"2018","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/ejcn.2017.58","article-title":"Mediterranean diet and multiple health outcomes: An umbrella review of meta-analyses of observational studies and randomised trials","volume":"72","author":"Dinu","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nestares, T., Mart\u00edn-Masot, R., Flor-Alemany, M., Bonavita, A., Maldonado, J., and Aparicio, V.A. (2021). Influence of Ultra-Processed Foods Consumption on Redox Status and Inflammatory Signaling in Young Celiac Patients. Nutrients, 13.","DOI":"10.3390\/nu13010156"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1111\/jhn.12800","article-title":"Influence of nutrition education in paediatric coeliac disease: Impact of the role of the registered dietitian: A prospective, single-arm intervention study","volume":"33","year":"2020","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_16","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 Celiac Disease on a Gluten-Free Diet: A Case-Control Prospective Study. Nutrients, 12.","DOI":"10.3390\/nu12010143"},{"key":"ref_17","unstructured":"(2022, October 01). SurveyMonkey. Available online: https:\/\/www.surveymonkey.com\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1080\/09637486.2021.1880552","article-title":"Reproducibility and validity of a food-frequency questionnaire (NFFQ) to assess food consumption based on the NOVA classification in adults","volume":"72","author":"Dinu","year":"2021","journal-title":"Int. J. Food. Sci. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1017\/S1368980013003169","article-title":"Mediterranean diet and health status: An updated meta-analysis and a proposal for a literature-based adherence score","volume":"17","author":"Sofi","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1080\/09637486.2017.1287884","article-title":"Validation of a literature-based adherence score to Mediterranean diet: The MEDI-LITE score","volume":"68","author":"Sofi","year":"2017","journal-title":"Int. J. Food. Sci. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Caio, G., Volta, U., Sapone, A., Leffler, D.A., De Giorgio, R., Catassi, C., and Fasano, A. (2019). Celiac disease: A comprehensive current review. BMC Med., 17.","DOI":"10.1186\/s12916-019-1380-z"},{"key":"ref_22","first-page":"296","article-title":"High fat consumption in children with celiac disease","volume":"72","author":"Ferrara","year":"2009","journal-title":"Acta Gastro-Enterol. Belg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/jhn.12026","article-title":"Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products","volume":"26","author":"Zuccotti","year":"2013","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4807","DOI":"10.1002\/jsfa.9083","article-title":"Detection of allergenic additives in processed meat products","volume":"98","author":"Spychaj","year":"2018","journal-title":"J. Sci. Food. Agric."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6258","DOI":"10.1017\/S1368980021002767","article-title":"Ultra-processed food consumption and its correlates among Italian children, adolescents and adults from the Italian Nutrition & Health Survey (INHES) cohort study","volume":"24","author":"Ruggiero","year":"2021","journal-title":"Public Health Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Perez-Junkera, G., V\u00e1zquez-Polo, M., Eizagirre, F.J., Benjumea, L., Tutau, C., Esteban, B., Miranda, J., Larretxi, I., Navarro, V., and Churruca, I. (2022). Application of a Platform for Gluten-Free Diet Evaluation and Dietary Advice: From Theory to Practice. Sensors, 22.","DOI":"10.3390\/s22030732"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.numecd.2019.11.003","article-title":"Trends in adherence to the Mediterranean diet in South Italy: A cross sectional study","volume":"30","author":"Veronese","year":"2020","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1017\/S1368980009990541","article-title":"Worldwide variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003","volume":"12","author":"Quintana","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/s41430-018-0313-9","article-title":"Worldwide adherence to Mediterranean Diet between 1960 and 2011","volume":"72","author":"Vilarnau","year":"2019","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1017\/S1368980017000234","article-title":"The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing","volume":"21","author":"Monteiro","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Dinu, M., Asensi, M.T., Pagliai, G., Lotti, S., Martini, D., Colombini, B., and Sofi, F. (2022). Consumption of Ultra-Processed Foods Is Inversely Associated with Adherence to the Mediterranean Diet: A Cross-Sectional Study. Nutrients, 14.","DOI":"10.3390\/nu14102073"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1017\/S0007114520002688","article-title":"Consumption of ultra-processed foods and health status: A systematic review and meta-analysis","volume":"125","author":"Pagliai","year":"2021","journal-title":"Br. J. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Su\u00e1rez-Gonz\u00e1lez, M., Bouso\u00f1o-Garc\u00eda, C., Jim\u00e9nez-Trevi\u00f1o, S., and D\u00edaz-Mart\u00edn, J.J. (2021). Gluten-Free Diet: Nutritional Strategies to Improve Eating Habits in Children with Celiac Disease: A Prospective, Single-arm Intervention Study. Nutrients, 13.","DOI":"10.3390\/nu13041108"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/4\/938\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:33:42Z","timestamp":1760121222000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/4\/938"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,13]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["nu15040938"],"URL":"https:\/\/doi.org\/10.3390\/nu15040938","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,13]]}}}