{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T02:28:45Z","timestamp":1779935325162,"version":"3.53.1"},"reference-count":83,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Funds through the FCT\u2014Foundation for Science and Technology, I.P.","award":["UIDB\/05507\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020"]}]},{"name":"National Funds through the FCT\u2014Foundation for Science and Technology, I.P.","award":["539\/2022"],"award-info":[{"award-number":["539\/2022"]}]},{"name":"National Funds through the FCT\u2014Foundation for Science and Technology, I.P.","award":["302602\/2021-6"],"award-info":[{"award-number":["302602\/2021-6"]}]},{"name":"Centre for Studies in Education and Innovation (CIDEI)","award":["UIDB\/05507\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020"]}]},{"name":"Centre for Studies in Education and Innovation (CIDEI)","award":["539\/2022"],"award-info":[{"award-number":["539\/2022"]}]},{"name":"Centre for Studies in Education and Innovation (CIDEI)","award":["302602\/2021-6"],"award-info":[{"award-number":["302602\/2021-6"]}]},{"name":"Polytechnic University of Viseu","award":["UIDB\/05507\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020"]}]},{"name":"Polytechnic University of Viseu","award":["539\/2022"],"award-info":[{"award-number":["539\/2022"]}]},{"name":"Polytechnic University of Viseu","award":["302602\/2021-6"],"award-info":[{"award-number":["302602\/2021-6"]}]},{"name":"FAPDF","award":["UIDB\/05507\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020"]}]},{"name":"FAPDF","award":["539\/2022"],"award-info":[{"award-number":["539\/2022"]}]},{"name":"FAPDF","award":["302602\/2021-6"],"award-info":[{"award-number":["302602\/2021-6"]}]},{"name":"Brazilian National Council for Scientific and Technological Development","award":["UIDB\/05507\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020"]}]},{"name":"Brazilian National Council for Scientific and Technological Development","award":["539\/2022"],"award-info":[{"award-number":["539\/2022"]}]},{"name":"Brazilian National Council for Scientific and Technological Development","award":["302602\/2021-6"],"award-info":[{"award-number":["302602\/2021-6"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The aim of this study is to assess Portuguese celiac patients\u2019 quality of life (QoL) perception. A cross-sectional study was performed with a non-probability convenience sample of Portuguese celiac patients using an online self-administered celiac disease quality of life questionnaire (CDQ), previously validated for the Portuguese population. The final sample comprised 234 celiac patients, which included the following: primarily women (69.2%); aged between 18 and 49 years old (56.4%); with a partner (60.6%); with a high educational level (58.9%\u2014graduated or post-graduated); following a gluten-free diet (GFD) (55.1%); and not using antidepressants (93.1%). The Portuguese CDQ presented good reliability and responsiveness in this sample of Portuguese celiac patients. In general, the CDQ in Portugal was affected by age at diagnosis (p = 0.017), educational level (p = 0.005), and compliance with GFD (p = 0.034). The emotion domain was affected only by using antidepressants (p = 0.036). The social domain was affected by gender (females had lower rates, p = 0.016), age at diagnosis (p = 0.009), educational level (p = 0.000), and compliance with a GFD (p = 0.002). The worries domain did not differ according to socioeconomic data. The symptoms domain was affected by compliance with GFD (p = 0.000), age at diagnosis (p = 0.000), and educational level (p = 0.014). Data on celiac QoL is essential to support the formulation and implementation of strategies to minimize the issues suffered by celiac patients, lowering their physical, emotional, and social burden. Additionally, data on Portuguese celiac disease patients using the CDQ will allow future comparative research among celiac populations from different countries.<\/jats:p>","DOI":"10.3390\/nu15092051","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T01:37:01Z","timestamp":1682386621000},"page":"2051","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Quality of Life Perception among Portuguese Celiac Patients: A Cross-Sectional Study Using the Celiac Disease Questionnaire (CDQ)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8103-7221","authenticated-orcid":false,"given":"Cl\u00e1udia","family":"Chaves","sequence":"first","affiliation":[{"name":"ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5286-2249","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Raposo","sequence":"additional","affiliation":[{"name":"CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lus\u00f3fona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0370-3089","authenticated-orcid":false,"given":"Renata Puppin","family":"Zandonadi","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia, Faculty of Health Sciences, Nutrition Department, Campus Universit\u00e1rio Darcy Ribeiro, Bras\u00edlia 70910-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9071-8512","authenticated-orcid":false,"given":"Eduardo Yoshio","family":"Nakano","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia, Department of Statistics, Bras\u00edlia 70910-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6043-819X","authenticated-orcid":false,"given":"Fernando","family":"Ramos","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal"},{"name":"Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Rua D. 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Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1231","DOI":"10.1016\/j.cgh.2020.09.052","article-title":"Latitude and Celiac Disease Prevalence: A Meta-Analysis and Meta-Regression","volume":"20","author":"Celdir","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.giec.2012.07.004","article-title":"Diagnosis of Celiac Disease","volume":"22","author":"Lebwohl","year":"2012","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.amjmed.2010.02.019","article-title":"Celiac Disease Diagnosis: Simple Rules Are Better than Complicated Algorithms","volume":"123","author":"Catassi","year":"2010","journal-title":"Am. J. Med."},{"key":"ref_6","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_7","doi-asserted-by":"crossref","unstructured":"Itzlinger, A., Branchi, F., Elli, L., Schumann, M., Itzlinger, A., Branchi, F., Elli, L., and Schumann, M. (2018). Gluten-Free Diet in Celiac Disease\u2014Forever and for All?. Nutrients, 10.","DOI":"10.3390\/nu10111796"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zysk, W., G\u0142\u0105bska, D., and Guzek, D. (2018). Social and Emotional Fears and Worries Influencing the Quality of Life of Female Celiac Disease Patients Following a Gluten-Free Diet. Nutrients, 10.","DOI":"10.3390\/nu10101414"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1001\/jamainternmed.2016.5254","article-title":"Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population","volume":"176","author":"Kim","year":"2016","journal-title":"JAMA Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1159\/000347180","article-title":"Gluten-Free Diet in Gluten-Related Disorders","volume":"31","author":"Mulder","year":"2013","journal-title":"Dig. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/01.mcg.0000225516.05666.4e","article-title":"Development and validation of the Celiac Disease Questionnaire (CDQ), a disease-specific health-related quality of life measure for adult patients with celiac disease","volume":"41","author":"Gold","year":"2007","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pratesi, C.B., H\u00e4user, W., Uenishi, R.H., Selleski, N., Nakano, E.Y., Gandolfi, L., Pratesi, R., and Zandonadi, R.P. (2018). Quality of Life of Celiac Patients in Brazil: Questionnaire Translation, Cultural Adaptation and Validation. Nutrients, 10.","DOI":"10.3390\/nu10091167"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1080\/10408398.2018.1541864","article-title":"Gluten Contamination in Food Services and Industry: A Systematic Review","volume":"60","author":"Falcomer","year":"2018","journal-title":"Crit. Rev. Food. Sci. Nutr."},{"key":"ref_14","first-page":"479","article-title":"Qualidade de Vida Da Pessoa Cel\u00edaca Adulta","volume":"1","author":"Monteiro","year":"2010","journal-title":"Int. J. Dev. Educ. Psychol."},{"key":"ref_15","unstructured":"WHO (2014). WHOQOL: Measuring Quality of Life, WHO."},{"key":"ref_16","unstructured":"World Health Organization (2008). The Third Ten Years of the World Health Organization, WHO. [1st ed.]."},{"key":"ref_17","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_18","unstructured":"(2023, January 17). Health-Related Quality of Life (HRQOL) | CDC, Available online: https:\/\/www.cdc.gov\/hrqol\/index.htm."},{"key":"ref_19","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_20","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":"Hauser","year":"2006","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_21","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_22","doi-asserted-by":"crossref","first-page":"3325","DOI":"10.1007\/s11136-020-02582-7","article-title":"Health-Related Quality of Life in Patients with Non-Functioning Pituitary Adenoma: A Special Focus on Hydrocortisone Replacement Dose","volume":"29","author":"Wild","year":"2020","journal-title":"Qual. Life Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11136-005-8486-9","article-title":"Do the SF-36 and WHOQOL-BREF Measure the Same Constructs? Evidence from the Taiwan Population","volume":"15","author":"Huang","year":"2006","journal-title":"Qual. Life Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S1699-258X(06)73024-8","article-title":"Adaptaci\u00f3n Transcultural y Validaci\u00f3n de Una Versi\u00f3n En Espa\u00f1ol de Un Instrumento Espec\u00edfico Para Medir Calidad de Vida Relacionada Con La Salud En Pacientes Con Espondilitis Anquilosante: El ASQoL","volume":"2","author":"Toyos","year":"2006","journal-title":"Reumatol. Cl\u00ednica"},{"key":"ref_25","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","volume":"51","author":"Bullinger","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_26","unstructured":"WHO (1997). World Health Organization Quality of Life Instruments (WHOQOL-BREF)-Seattle Quality of Life Group-Measure and Improve Health Disparities in Children, Adolescents, Adults from Stigmatized Populations, WHO."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1007\/s11136-017-1632-3","article-title":"A Comprehensive Questionnaire for the Assessment of Health-Related Quality of Life in Coeliac Disease (CDQL)","volume":"26","author":"Skjerning","year":"2017","journal-title":"Qual. Life Res."},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"585","DOI":"10.4321\/S1130-01082013001000003","article-title":"Transcultural Adaptation and Validation of the Celiac Disease Quality of Life Transcultural Adaptation and Validation of the Celiac Disease Quality of Life (CD-QOL) Survey, a Specific Questionnaire to Measure Quality of Life in Patients with Celiac Dis","volume":"105","author":"Casellas","year":"2013","journal-title":"Rev. Espan\u00f5la De Enferm. Dig."},{"key":"ref_30","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_31","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/MCG.0000000000000433","article-title":"Quality of Life in Screen-Detected Celiac Disease Patients in the United States","volume":"50","author":"Mahadev","year":"2016","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_32","first-page":"124","article-title":"Quality of Life in Celiac Disease and the Effect of Gluten-Free Diet","volume":"2","author":"Deepak","year":"2018","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e1106","DOI":"10.31661\/gmj.v7i0.1106","article-title":"Transcultural Adaptation and Validation of Persian Version of Celiac Disease Questionnaire (CDQ); A Specific Questionnaire to Measure Quality of Life of Iranian Patients","volume":"7","author":"Barzegar","year":"2018","journal-title":"Galen Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1038\/s41598-020-58236-8","article-title":"Quality of Life in People with Ongoing Symptoms of Coeliac Disease despite Adherence to a Strict Gluten-Free Diet","volume":"10","author":"Harnett","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Selleski, N., Zandonadi, R.P., Milde, L.B., Gandolfi, L., Pratesi, R., H\u00e4user, W., Uenishi, R.H., Nakano, E.Y., and Pratesi, C.B. (2020). Evaluation of Quality of Life of Adult Patients with Celiac Disease in Argentina: From Questionnaire Validation to Assessment. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17197051"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.ajg.2022.06.009","article-title":"Quality of Life of Moroccan Patients with Celiac Disease: Arabic Translation, Cross-Cultural Adaptation, and Validation of the Celiac Disease Questionnaire","volume":"23","author":"Guennouni","year":"2022","journal-title":"Arab. J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1556\/650.2021.32258","article-title":"A Sz\u00e9gyen Medi\u00e1ci\u00f3s Szerepe a Stigma \u00c9s Az \u00c9letmin\u0151s\u00e9g Kapcsolat\u00e1ban Coeliaki\u00e1ban Szenved\u0151 Betegek K\u00f6r\u00e9ben.: A 8 T\u00e9teles Stigmatiz\u00e1ci\u00f3 Kr\u00f3nikus Betegs\u00e9gekben K\u00e9rd\u0151\u00edv Magyar Adapt\u00e1l\u00e1sa","volume":"162","author":"Henrietta","year":"2021","journal-title":"Orv. Hetil."},{"key":"ref_38","first-page":"1","article-title":"Development of the Portuguese Version of the Celiac Disease Questionnaire","volume":"2","author":"Monteiro","year":"2013","journal-title":"Soc. Rev. Int. Soc. Sci. Rev.\/Rev. Int. De Cienc. Soc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00038-020-01451-x","article-title":"Worldwide Public Policies for Celiac Disease: Are Patients Well Assisted?","volume":"65","author":"Falcomer","year":"2020","journal-title":"Int. J. Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ecns.2021.03.006","article-title":"Using Social Media and Snowball Sampling as an Alternative Recruitment Strategy for Research","volume":"55","author":"Leighton","year":"2021","journal-title":"Clin. Simul. Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/08943184211010471","article-title":"Recruitment Strategies to Optimize Participation by Diverse Populations","volume":"34","author":"Aquino","year":"2021","journal-title":"Nurs. Sci. Q."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_43","unstructured":"Kenny, D.A., and Little, T.D. (2011). Principles and Practice of Structural Equation Modeling, The Guilford Press. [3rd ed.]."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1365-277X.2012.01288.x","article-title":"Living with Coeliac Disease and a Gluten-Free Diet: A Canadian Perspective","volume":"26","author":"Zarkadas","year":"2013","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1038\/ajg.2014.29","article-title":"Patient Perception of Treatment Burden Is High in Celiac Disease Compared with Other Common Conditions","volume":"109","author":"Shah","year":"2014","journal-title":"Am. J. Gastroenterol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Marsilio, I., Canova, C., D\u2019Odorico, A., Ghisa, M., Zingone, L., Lorenzon, G., Savarino, E.V., and Zingone, F. (2020). Quality-of-Life Evaluation in Coeliac Patients on a Gluten-Free Diet. Nutrients, 12.","DOI":"10.3390\/nu12102981"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Violato, M., Gray, A., Papanicolas, I., and Ouellet, M. (2012). Resource Use and Costs Associated with Coeliac Disease before and after Diagnosis in 3,646 Cases: Results of a UK Primary Care Database Analysis. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0041308"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"507","DOI":"10.14309\/ajg.0000000000000523","article-title":"Incidence of Celiac Disease Is Increasing over Time: A Systematic Review and Meta-Analysis","volume":"115","author":"King","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Elli, L., Barisani, D., Vaira, V., Bardella, M.T., Topa, M., Vecchi, M., Doneda, L., Scricciolo, A., Lombardo, V., and Roncoroni, L. (2020). How to Manage Celiac Disease and Gluten-Free Diet during the COVID-19 Era: Proposals from a Tertiary Referral Center in a High-Incidence Scenario. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01524-4"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kreutz, J.M., Heynen, L., Arayess, L., and Vreugdenhil, A.C.E. (2023). Celiac Disease and the Gluten Free Diet during the COVID-19 Pandemic: Experiences of Children and Parents. Medicina, 59.","DOI":"10.3390\/medicina59030425"},{"key":"ref_51","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_52","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_53","doi-asserted-by":"crossref","unstructured":"Gadelha De Mattos, Y.A., Zandonadi, R.P., Gandolfi, L., Pratesi, R., Nakano, E.Y., and Pratesi, C.B. (2019). Self-Reported Non-Celiac Gluten Sensitivity in Brazil: Translation, Cultural Adaptation, and Validation of Italian Questionnaire. Nutrients, 11.","DOI":"10.3390\/nu11040781"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Roncoroni, L., Bascu\u00f1\u00e1n, K.A., Vecchi, M., Doneda, L., Bardella, M.T., Lombardo, V., Scricciolo, A., Branchi, F., and Elli, L. (2019). Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (Ncgs): An Exploratory Study. Nutrients, 11.","DOI":"10.3390\/nu11010136"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Falcomer, A.L., Farage, P., Pratesi, C.B., Pratesi, R., Gandolfi, L., Nakano, E.Y., Raposo, A., and Zandonadi, R.P. (2021). Health-Related Quality of Life and Experiences of Brazilian Celiac Individuals over the Course of the Sars-Cov-2 Pandemic. Nutrients, 13.","DOI":"10.3390\/nu13051582"},{"key":"ref_56","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_57","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_58","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_59","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1365-277X.2005.00591.x","article-title":"\u2019Controlled by Food\u2019\u2014Lived Experiences of Coeliac Disease","volume":"18","author":"Sverker","year":"2005","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jpg.2013.09.006","article-title":"Perce\u00e7\u00e3o Do Estado de Sa\u00fade e Da Qualidade de Vida Numa Amostra de Cel\u00edacos Portugueses","volume":"21","author":"Pinto","year":"2014","journal-title":"GE J. Port. Gastrenterologia"},{"key":"ref_61","first-page":"281","article-title":"Reliability and Validity in Measuring Physical and Mental Health Construct of the Portuguese Version of MOS SF-36","volume":"19","author":"Severo","year":"2006","journal-title":"Acta Med. Port."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2050312116671725","DOI":"10.1177\/2050312116671725","article-title":"SF-36 Total Score as a Single Measure of Health-Related Quality of Life: Scoping Review","volume":"4","author":"Lins","year":"2016","journal-title":"SAGE Open Med."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Paarlahti, P., Kurppa, K., Ukkola, A., Collin, P., Huhtala, H., M\u00e4ki, M., and Kaukinen, K. (2013). Predictors of Persistent Symptoms and Reduced Quality of Life in Treated Coeliac Disease Patients: A Large Cross-Sectional Study. BMC Gastroenterol., 13.","DOI":"10.1186\/1471-230X-13-75"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.3389\/fpsyg.2020.01900","article-title":"Mindfulness, Age and Gender as Protective Factors against Psychological Distress during COVID-19 Pandemic","volume":"11","author":"Conversano","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ejon.2019.04.003","article-title":"Mindfulness Dispositions and Defense Style as Positive Responses to Psychological Distress in Oncology Professionals","volume":"40","author":"Ciacchini","year":"2019","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1097\/NMD.0000000000001230","article-title":"Defense Mechanisms, Gender, and Adaptiveness in Emerging Personality Disorders in Adolescent Outpatients","volume":"208","author":"Perry","year":"2020","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Carmassi, C., Stratta, P., Massimetti, G., Bertelloni, A.A., Conversano, C., Cremone, M.M., Miccoli, M., Baggiani, A., Rossi, A., and Dell\u2019Osso, L. (2014). New DSM-5 Maladaptive Symptoms in PTSD: Gender Differences and Correlations with Mood Spectrum Symptoms in a Sample of High School Students Following Survival of an Earthquake. Ann. Gen. Psychiatry, 13.","DOI":"10.1186\/s12991-014-0028-9"},{"key":"ref_68","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_69","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_70","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_71","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_72","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_73","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_74","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1586\/egh.10.81","article-title":"Celiac Disease and Health-Related Quality of Life","volume":"5","author":"Kurppa","year":"2014","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_75","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_76","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1111\/jhn.12477","article-title":"The Economic Burden of Gluten-Free Products and Gluten-Free Diet: A Cost Estimation Analysis in Greece","volume":"30","author":"Panagiotou","year":"2017","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1159\/000369504","article-title":"Celiac Disease and the Gluten-Free Diet: Consequences and Recommendations for Improvement","volume":"33","author":"Theethira","year":"2015","journal-title":"Dig. Dis."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"275","DOI":"10.12998\/wjcc.v3.i3.275","article-title":"Clinical and Diagnostic Aspects of Gluten Related Disorders","volume":"3","author":"Tovoli","year":"2015","journal-title":"World J. Clin. Cases"},{"key":"ref_79","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_80","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_81","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_82","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1053\/gast.2001.22123","article-title":"Current Approaches to Diagnosis and Treatment of Celiac Disease: An Evolving Spectrum","volume":"120","author":"Fasano","year":"2001","journal-title":"Gastroenterology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/MCG.0b013e31827a6f83","article-title":"World Gastroenterology Organisation Global Guidelines on Celiac Disease","volume":"47","author":"Bai","year":"2013","journal-title":"J. Clin. Gastroenterol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/9\/2051\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:22:28Z","timestamp":1760124148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/9\/2051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,24]]},"references-count":83,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["nu15092051"],"URL":"https:\/\/doi.org\/10.3390\/nu15092051","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,24]]}}}