{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:41:11Z","timestamp":1788475271368,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"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>Lifelong adherence to a gluten-free diet (GFD) is the cornerstone of management of celiac disease (CD), but adhering to a GFD can be hard. Although several factors are positively associated with adherence of pediatric CD patients to a GFD, it is unknown whether these are influenced by variability caused by the specific tool used to assess adherence to a GFD. Here, we aimed to evaluate how individual patient characteristics and dietary counselling by a trained dietitian influence adherence to a GFD in children with CD, as assessed by two validated questionnaires: the Biagi questionnaire and the Leffler short questionnaire adapted for pediatric patients. Some 139 children and adolescents were recruited in a cross-sectional, multicenter study. Concordance between the two questionnaires in defining adherence was fair (weighted Cohen\u2019s kappa coefficient 0.39, 95%CI 0.19\u20130.60). Upon regression analysis, having a cohabiting family member with CD, being of Italian origin, and receiving specialized dietary counselling during follow-up were found to positively influence stricter adherence to a GFD for children with CD. Neither questionnaire detected a significant relationship between adherence to a GFD and the presence of symptoms after gluten ingestion. This study provides important new data on the factors influencing GFD adherence in the pediatric population, and highlights the importance of dietician input and overcoming language and cultural barriers when educating patients.<\/jats:p>","DOI":"10.3390\/nu15112455","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T02:00:55Z","timestamp":1684980055000},"page":"2455","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Determinants of Adherence to a Gluten-Free Diet in Children with Celiac Disease and the Influence of the Methods Used to Assess It"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6676-5773","authenticated-orcid":false,"given":"Alice","family":"Monzani","sequence":"first","affiliation":[{"name":"Division of Pediatrics, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Marcolin","sequence":"additional","affiliation":[{"name":"Italian Celiac Association, Piedmont Section, 10136 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Giorda","sequence":"additional","affiliation":[{"name":"Italian Celiac Association, Piedmont Section, 10136 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Epis","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maristella","family":"Babral","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5127-1685","authenticated-orcid":false,"given":"Kevin","family":"Valentino","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Scotti","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5997-7057","authenticated-orcid":false,"given":"Enrico","family":"Felici","sequence":"additional","affiliation":[{"name":"Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4173-146X","authenticated-orcid":false,"given":"Ivana","family":"Rabbone","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S121","DOI":"10.1053\/j.gastro.2005.02.024","article-title":"Dietary guidelines and implementation for celiac disease","volume":"128","author":"Kupper","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_2","first-page":"562","article-title":"Rate, risk factors, and outcomes of nonadherence in pediatric patients with celiac disease: A systematic review","volume":"1","author":"Reilly","year":"2020","journal-title":"Clin. 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