{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:26:37Z","timestamp":1787934397582,"version":"build-2784847793"},"reference-count":43,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T00:00:00Z","timestamp":1749340800000},"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>Background: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion. The only effective treatment is adherence to a gluten-free diet (GFD), which is challenging due to the widespread presence of gluten in foods and the lack of physical and financial access to gluten-free options, among other factors that can lead to food nutrition insecurity (FNI). FNI, defined as the difficulty in accessing adequate food, is a factor that not only affects the need to adhere to a GFD but also compromises adherence itself. Objective: Review the scientific literature on the association between FNI, celiac disease, and adherence to a gluten-free diet. Methodology: This integrative review was conducted systematically using the PubMed, Scopus, and Web of Science databases, selecting studies that evaluated food security and insecurity among celiac patients. The keywords used with the Boolean operators were \u201cceliac disease\u201d AND\/OR \u201cgluten-free diet\u201d AND \u201cfood insecurity\u201d AND\/OR \u201cfood security\u201d. The search did not restrict language or geographic location, and studies were selected independently by two reviewers. Results: Ten publications met the inclusion criteria and were selected for the integrative review. FNI has been studied over the last five years in CD patients, but there is a lack of studies in different regions. FNI negatively affects the quality of life for those with CD and contributes to more severe symptoms and lower adherence to the GFD, especially in children and low-income families. Factors associated with higher risks of FNI in those with celiac disease include income, education, living in rural or non-central areas, and availability. These factors reinforce the negative impact of the association between FNI and adherence to the GFD in CD patients. Conclusions: The study of FNI in celiac individuals is a relatively recent development. The prevalence of FNI in this population is concerning and higher than in the general population, and it is associated with adherence to the GFD. Therefore, this topic demands extensive public policies to improve the health, quality of life, adherence, and treatment of CD patients.<\/jats:p>","DOI":"10.3390\/nu17121956","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T04:23:02Z","timestamp":1749442982000},"page":"1956","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Celiac Disease and Gluten-Free Diets: A Path or Barrier to Food (In)Security?"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2770-1603","authenticated-orcid":false,"given":"Camila dos Santos","family":"Ribeiro","sequence":"first","affiliation":[{"name":"Department of Nutrition, University of Bras\u00edlia, Bras\u00edlia 70910-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia B.","family":"Pratesi","sequence":"additional","affiliation":[{"name":"College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA"}],"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":"Department of Nutrition, University of Bras\u00edlia, Bras\u00edlia 70910-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,8]]},"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":"2419","DOI":"10.1056\/NEJMcp1113994","article-title":"Clinical Practice Celiac Disease","volume":"367","author":"Fasano","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_3","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_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5409\/wjcp.v10.i4.53","article-title":"Celiac Disease in Children: A Review of the Literature","volume":"10","author":"Sahin","year":"2021","journal-title":"World J. Clin. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Taraghikhah, N., Ashtari, S., Asri, N., Shahbazkhani, B., Al-Dulaimi, D., Rostami-Nejad, M., Rezaei-Tavirani, M., Razzaghi, M.R., and Zali, M.R. (2020). An Updated Overview of Spectrum of Gluten-Related Disorders: Clinical and Diagnostic Aspects. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01390-0"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ejim.2011.09.016","article-title":"Developing Strategies to Improve the Quality of Life of Patients with Gluten Intolerance in Patients with and without Coeliac Disease","volume":"23","author":"Bernardo","year":"2012","journal-title":"Eur. J. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/apt.12893","article-title":"Histological Recovery and Gluten-Free Diet Adherence: A Prospective 1-Year Follow-up Study of Adult Patients with Coeliac Disease","volume":"40","author":"Galli","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wieser, H., Ruiz-Carnicer, \u00c1., Segura, V., Comino, I., and Sousa, C. (2021). Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease. Nutrients, 13.","DOI":"10.3390\/nu13072274"},{"key":"ref_9","first-page":"377","article-title":"Study of Adherence to the Gluten-Free Diet in Coeliac Patients","volume":"94","year":"2021","journal-title":"An. Pediatr. (Engl. Ed.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/apt.13319","article-title":"Factors Governing Long-Term Adherence to a Gluten-Free Diet in Adult Patients with Coeliac Disease","volume":"42","author":"Vanga","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/1747-0080.12171","article-title":"Cost and Affordability of a Nutritionally Balanced Gluten-Free Diet: Is Following a Gluten-Free Diet Affordable?","volume":"73","author":"Lambert","year":"2016","journal-title":"Nutr. Diet."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Elsahoryi, N.A., Ibrahim, M.O., and Alhaj, O.A. (2024). Adherence to the Gluten-Free Diet Role as a Mediating and Moderating of the Relationship between Food Insecurity and Health-Related Quality of Life in Adults with Celiac Disease: Cross-Sectional Study. Nutrients, 16.","DOI":"10.3390\/nu16142229"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, X., Anders, S., Jiang, Z., Bruce, M., Gidrewicz, D., Marcon, M., Turner, J.M., and Mager, D.R. (2024). Food Insecurity Impacts Diet Quality and Adherence to the Gluten-Free Diet in Youth with Celiac Disease. J. Pediatr. Gastroenterol. Nutr., 1180\u20131191.","DOI":"10.1002\/jpn3.12398"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Peng, W., and Berry, E.M. (2018). The Concept of Food Security, Elsevier.","DOI":"10.1016\/B978-0-08-100596-5.22314-7"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gallegos, D., Eivers, A., Sondergeld, P., and Pattinson, C. (2021). Food Insecurity and Child Development: A State-of-the-Art Review. Int. J. Env. Res. Public. Health, 18.","DOI":"10.3390\/ijerph18178990"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102163","DOI":"10.1016\/j.foodpol.2021.102163","article-title":"Viewpoint: Rigorous Monitoring Is Necessary to Guide Food System Transformation in the Countdown to the 2030 Global Goals","volume":"104","author":"Fanzo","year":"2021","journal-title":"Food Policy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1056\/NEJMra2406458","article-title":"Effects of Food and Nutrition Insecurity on Global Health","volume":"392","author":"Gallegos","year":"2025","journal-title":"N. Engl. J. Med. Rev."},{"key":"ref_18","unstructured":"FAO, IFAD, WHO, UNICEF, and WFP (2024). The State of Food Security and Nutrition in the World 2024\u2014Financing to End Hunger, Food Insecurity and Malnutrition in All Its Forms, FAO."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"29S","DOI":"10.1016\/S0022-3182(12)80135-X","article-title":"The Community Childhood Hunger Identification Project: A Model of Domestic Hunger\u2014Demonstration Project in Seattle, Washington","volume":"24","author":"Wehler","year":"1992","journal-title":"J. Nutr. Educ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1590\/1415-52732014000200010","article-title":"Refinement of the Brazilian Household Food Insecurity Measurement Scale: Recommendation for a 14-Item EBIA","volume":"27","year":"2014","journal-title":"Rev. De Nutr."},{"key":"ref_21","first-page":"107","article-title":"The impact of food insecurity on adherence to a gluten-free diet in the adult celiac disease population attending a dedicated celiac clinic","volume":"58","author":"Leong","year":"2023","journal-title":"Proc. Int. J. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Al-sunaid, F.F., Al-homidi, M.M., Al-qahtani, R.M., Al-ashwal, R.A., Mudhish, G.A., Hanbazaza, M.A., and Al-zaben, A.S. (2021). The Influence of a Gluten-Free Diet on Health-Related Quality of Life in Individuals with Celiac Disease. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01908-0"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"931","DOI":"10.14309\/ajg.0000000000001778","article-title":"Brief Communication: Survey Based Study on Food Insecurity during COVID-19 for Households with Children on a Prescribed Gluten-Free Diet","volume":"117","author":"Du","year":"2022","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S-735","DOI":"10.1016\/S0016-5085(24)02167-X","article-title":"Su1338 food insecurity negatively impacts gluten-free diet adherence and is associated with persistent symptoms in adult patients with celiac disease","volume":"166","author":"Leong","year":"2024","journal-title":"Proc. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e088069","DOI":"10.1136\/bmjopen-2024-088069","article-title":"Food Insecurity and Other Barriers to Adherence to a Gluten-Free Diet in Individuals with Celiac Disease and Non-Celiac Gluten Sensitivity in the Netherlands: A Mixed-Methods Study","volume":"14","author":"Smeets","year":"2024","journal-title":"BMJ Open"},{"key":"ref_26","first-page":"192","article-title":"Assessing the Prevalence of Food Insecurity among Children with Celiac Disease: A Cross-Sectional Study","volume":"7","author":"Khalifeh","year":"2019","journal-title":"J. Food Secur."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1097\/MCG.0000000000001646","article-title":"Food Insecurity Negatively Impacts Gluten Avoidance and Nutritional Intake in Patients With Celiac Disease","volume":"56","author":"Ma","year":"2022","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Siminiuc, R., and \u1e6curcanu, D. (2022). Food Security of People with Celiac Disease in the Republic of Moldova through Prism of Public Policies. Front. Public. Health, 10.","DOI":"10.3389\/fpubh.2022.961827"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Catassi, C., and Chirdo, F.G. (2025). The Gluten-Free Diet: The Road Ahead. Nutrients, 17.","DOI":"10.3390\/nu17071226"},{"key":"ref_30","unstructured":"WHO, Palmquist, A., FAO, IFAD, UNICEF, and WFP (2025, April 04). Hunger Numbers Stubbornly High for Three Consecutive Years as Global Crises Deepen: UN Report. Available online: https:\/\/www.who.int\/news\/item\/24-07-2024-hunger-numbers-stubbornly-high-for-three-consecutive-years-as-global-crises-deepen--un-report."},{"key":"ref_31","first-page":"23","article-title":"Patient and Community Health Global Burden in a World with More Celiac Disease","volume":"167","author":"Gatti","year":"2024","journal-title":"Gastroenterology"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Olaimat, A.N., Alshami, I.K., Al Hourani, H., Sarhan, W., Al-holy, M., Abughoush, M., Al-awwad, N.J., Hoteit, M., and Al-jawaldeh, A. (2022). Food Insecurity, Dietary Diversity, and Coping Strategies A Cross-Sectional Study. Nutrients, 14.","DOI":"10.3390\/nu14112252"},{"key":"ref_33","first-page":"90","article-title":"Prevalence and Correlates of Food Insecurity among Children in High-Income European Countries. A Systematic Review","volume":"56","author":"Caprini","year":"2020","journal-title":"Ann. Ist. Super. Sanit\u00e0"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1093\/advances\/nmz111","article-title":"Food Insecurity among College Students in the United States: A Scoping Review","volume":"11","author":"Nikolaus","year":"2020","journal-title":"Adv. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Arzhang, P., Abbasi, S.H., Sarsangi, P., Malekahmadi, M., Nikbaf-Shandiz, M., Bellissimo, N., and Azadbakht, L. (2022). Prevalence of Household Food Insecurity among a Healthy Iranian Population: A Systematic Review and Meta-Analysis. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.1006543"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s13668-023-00470-3","article-title":"Measuring Food Insecurity in India: A Systematic Review of the Current Evidence","volume":"12","author":"McKay","year":"2023","journal-title":"Curr. Nutr. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Amirian, P., Zarpoosh, M., Moradi, S., and Jalili, C. (2023). Celiac Disease and COVID-19 in Adults: A Systematic Review. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0285880"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"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_39","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1136\/gutjnl-2011-301346","article-title":"The Oslo Definitions for Coeliac Disease and Related Terms","volume":"62","author":"Ludvigsson","year":"2013","journal-title":"Gut"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"110537","DOI":"10.1016\/j.jpsychores.2021.110537","article-title":"Systematic Review: Exploration of the Impact of Psychosocial Factors on Quality of Life in Adults Living with Coeliac Disease","volume":"147","author":"Hayes","year":"2021","journal-title":"J. Psychosom. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1136\/flgastro-2018-101088","article-title":"Are Gluten-Free Food Staples Accessible to All Patients with Coeliac Disease?","volume":"10","author":"Hanci","year":"2019","journal-title":"Frontline Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Lee, A.R., Wolf, R.L., Lebwohl, B., Ciaccio, E.J., and Green, P.H.R. (2019). Persistent Economic Burden of the Gluten Free Diet. Nutrients, 11.","DOI":"10.3390\/nu11020399"},{"key":"ref_43","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."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/12\/1956\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:48:32Z","timestamp":1760032112000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/12\/1956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,8]]},"references-count":43,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["nu17121956"],"URL":"https:\/\/doi.org\/10.3390\/nu17121956","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,8]]}}}