{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:30:21Z","timestamp":1789504221431,"version":"build-2803163510"},"reference-count":131,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ONFOOD\u2014Research and Network on Food and Nutrition Sustainability, Safety and Security","award":["H93C2200063001"],"award-info":[{"award-number":["H93C2200063001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: In pediatric celiac disease (CD), intestinal malabsorption and the restrictive nature of a gluten-free diet (GFD) frequently result in persistent macro- and micronutrient imbalances, despite histological remission. The present review evaluates the evidence on nutritional adequacy of the GFD, identifies common deficiencies, and considers biomarker strategies and dietary recommendations to optimize growth and metabolic health. Methods: A narrative review of the literature was conducted, focusing on studies of nutrient intake, product composition of gluten-free foods, biomarker assessment, and clinical outcomes in children with CD. Both macronutrient (protein, fat, carbohydrate, fiber) and micronutrient (iron, vitamin D, calcium, B-vitamins, zinc, magnesium) domains were included. Results: Children with CD on long-term GFD demonstrate higher intake of lipids (especially saturated fat) and simple carbohydrates, alongside consistently low intake of dietary fiber and key micronutrients. Gluten-free products often exhibit lower protein content, higher glycemic index, and reduced fortification compared to gluten-containing equivalents. Nutritional deficits contribute to impaired linear growth, delayed puberty and increased metabolic risk. Conclusions: Nutritional adequacy of the GFD cannot be assumed in children with CD. Routine monitoring using standardized biomarker panels, combined with personalized dietary counseling and improved formulation and fortification of gluten-free products, is essential to mitigate long-term adverse outcomes. Future work should advance precision nutrition approaches and public-health initiatives to optimize dietary quality in this vulnerable population.<\/jats:p>","DOI":"10.3390\/nu17233741","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T08:44:28Z","timestamp":1764751468000},"page":"3741","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Celiac Disease as a Model of Intestinal Malnutrition: Mechanisms and Nutritional Management"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6564-4788","authenticated-orcid":false,"given":"Vanessa Nadia","family":"Dargenio","sequence":"first","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Sgarro","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"La Grasta","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Begucci","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania Paola","family":"Castellaneta","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costantino","family":"Dargenio","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Paulucci","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4603-974X","authenticated-orcid":false,"given":"Ruggiero","family":"Francavilla","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5849-8110","authenticated-orcid":false,"given":"Fernanda","family":"Cristofori","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Pediatric Section, Children\u2019s Hospital \u2018Giovanni XXIII\u2019, University of Bari \u201cAldo Moro\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cena, H., and Calder, P.C. 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