{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:01:01Z","timestamp":1789682461235,"version":"4.0.1"},"reference-count":32,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Regional Government of Andalusia","award":["P21_00101"],"award-info":[{"award-number":["P21_00101"]}]},{"award":["P21_00101"],"award-info":[{"award-number":["P21_00101"]}],"id":[{"id":"https:\/\/ror.org\/01jem9c82","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Celiac disease (CD) is a complex multifactorial disorder driven by genetic susceptibility and environmental triggers, with ultra-processed foods (UPFs) acting as potential disruptors of immune homeostasis. This study aimed to characterize the patterns and temporality of UPF consumption in a pediatric population with CD to provide evidence-based insights that can optimize the nutritional quality of a gluten-free diet (GFD) beyond mere gluten avoidance. Methods: A total of 128 children aged 5\u201314 years were enrolled, comprising a baseline cohort of 48 children newly diagnosed with CD (pre-GFD), 88 patients who had followed a GFD for at least 6 months (post-GFD), including 44 participants from the pre-GFD cohort prospectively re-evaluated after 12 months and 44 additional patients with established GFD adherence and a control group of 36 healthy children (CTRL). Dietary intake was assessed using three-day 24 h recalls. Food processing levels were determined using the NOVA classification system, and adherence to the Mediterranean Diet was evaluated via the KIDMED index. Results: At baseline, UPFs (NOVA 4) were the primary daily energy source for both celiac patients and controls, accounting for over 57% of total caloric intake, peaking during breakfast (~74%) and afternoon snacks (~81%). Longitudinal analysis showed that the nutritional profile and global UPF consumption remained remarkably stable after 12 months on a GFD, though a significant increase in vitamin B6 intake was observed (0.9 \u00b1 0.4 vs. 1.1 \u00b1 0.5 mg; p = 0.034). However, meal-pattern shifts occurred over the 12 months: celiac children significantly reduced their daily intake of culinary ingredients (NOVA 2; p = 0.029) and processed foods (NOVA 3; p = 0.025). Compared to healthy controls, post-GFD patients exhibited significantly lower Vitamin D intakes (4.6 \u00b1 9.4 vs. 6.2 \u00b1 12.3 \u00b5g\/day; p = 0.008), meeting only 30.8% of the reference intake. Both groups presented inadequate intakes of iron, calcium, folate, magnesium, and zinc. Conclusions: Pediatric celiac patients exhibit a high, deeply ingrained consumption of UPFs that mirrors healthy controls and persists 12 months after starting a GFD. While the GFD alters meal processing dynamics, it fails to resolve baseline micronutrient insufficiencies and is associated with lower dietary vitamin D intake, highlighting the urgent need for targeted nutritional interventions that focus on whole food quality rather than just gluten elimination.<\/jats:p>","DOI":"10.3390\/nu18132173","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"2173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patterns of Ultra-Processed Food Consumption in a Gluten-Free Diet: A Target for Nutritional Intervention"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9573-3244","authenticated-orcid":false,"given":"Teresa","family":"Nestares","sequence":"first","affiliation":[{"name":"Departamento de Fisiolog\u00eda, Facultad de Farmacia, Universidad de Granada, 18071 Granada, Spain"},{"name":"Instituto de Nutrici\u00f3n y Tecnolog\u00eda de los Alimentos \u201cJos\u00e9 Mataix Verd\u00fa\u201d (INYTA), Centro de Investigaci\u00f3n Biom\u00e9dica (CIBM), Universidad de Granada, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7362-9032","authenticated-orcid":false,"given":"Mar\u00eda","family":"Jim\u00e9nez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Hospital la Serran\u00eda, 29400 Ronda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8256-5053","authenticated-orcid":false,"given":"Marta","family":"Flor-Alemany","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Science, Campus of Melilla, University of Granada, 52001 Melilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4093-4900","authenticated-orcid":false,"given":"Marta","family":"Herrador-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Secci\u00f3n de Gastroenterolog\u00eda y Nutrici\u00f3n Infantil, Hospital Regional Universitario de M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5471-5824","authenticated-orcid":false,"given":"Lara","family":"Bossini-Castillo","sequence":"additional","affiliation":[{"name":"Departamento de Gen\u00e9tica, Instituto de Biotecnolog\u00eda, Centro de Investigaci\u00f3n Biom\u00e9dica (CIBM), Universidad de Granada, 18071 Granada, Spain"},{"name":"Reproducci\u00f3n Humana y Enfermedades Hereditarias y Complejas (IBS-TEC14), Terapias Avanzadas y Tecnolog\u00edas Biom\u00e9dicas, Instituto de Investigaci\u00f3n Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-8423","authenticated-orcid":false,"given":"Irene","family":"Zapata-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Departamento de Farmacolog\u00eda y Pediatr\u00eda, Facultad de Medicina, Universidad de M\u00e1laga, 29071 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3004-252X","authenticated-orcid":false,"given":"V\u00edctor Manuel","family":"Navas-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Secci\u00f3n de Gastroenterolog\u00eda y Nutrici\u00f3n Infantil, Hospital Regional Universitario de M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0113-9904","authenticated-orcid":false,"given":"Rafael","family":"Mart\u00edn-Masot","sequence":"additional","affiliation":[{"name":"Instituto de Nutrici\u00f3n y Tecnolog\u00eda de los Alimentos \u201cJos\u00e9 Mataix Verd\u00fa\u201d (INYTA), Centro de Investigaci\u00f3n Biom\u00e9dica (CIBM), Universidad de Granada, 18071 Granada, Spain"},{"name":"Secci\u00f3n de Gastroenterolog\u00eda y Nutrici\u00f3n Infantil, Hospital Regional Universitario de M\u00e1laga, 29010 M\u00e1laga, Spain"},{"name":"Departamento de Farmacolog\u00eda y Pediatr\u00eda, Facultad de Medicina, Universidad de M\u00e1laga, 29071 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Masot, R., Diaz-Castro, J., Moreno-Fernandez, J., Navas-L\u00f3pez, V.M., and Nestares, T. (2020). The Role of Early Programming and Early Nutrition on the Development and Progression of Celiac Disease: A Review. Nutrients, 12.","DOI":"10.20944\/preprints202010.0115.v1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"530","DOI":"10.3109\/07853890.2010.514285","article-title":"Natural History of Celiac Disease Autoimmunity in a USA Cohort Followed since 1974","volume":"42","author":"Catassi","year":"2010","journal-title":"Ann. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1038\/nrgastro.2015.90","article-title":"Novel Players in Coeliac Disease Pathogenesis: Role of the Gut Microbiota","volume":"12","author":"Verdu","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1038\/mi.2012.4","article-title":"Oral Tolerance to Food Protein","volume":"5","author":"Pabst","year":"2012","journal-title":"Mucosal Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.cell.2014.03.011","article-title":"Role of the Microbiota in Immunity and Inflammation","volume":"157","author":"Belkaid","year":"2014","journal-title":"Cell"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1007\/s00125-015-3614-8","article-title":"A Model for the Role of Gut Bacteria in the Development of Autoimmunity for Type 1 Diabetes","volume":"58","author":"Triplett","year":"2015","journal-title":"Diabetologia"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nestares, T., Mart\u00edn-Masot, R., Labella, A., Aparicio, V.A., Flor-Alemany, M., L\u00f3pez-Fr\u00edas, M., and Maldonado, J. (2020). Is a Gluten-Free Diet Enough to Maintain Correct Micronutrients Status in Young Patients with Celiac Disease?. Nutrients, 12.","DOI":"10.3390\/nu12030844"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1002\/jpn3.12079","article-title":"Gluten-Free Diet for Pediatric Patients with Coeliac Disease: A Position Paper from the ESPGHAN Gastroenterology Committee, Special Interest Group in Coeliac Disease","volume":"78","author":"Luque","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Masot, R., Herrador-L\u00f3pez, M., Navas-L\u00f3pez, V.M., Carmona, F.D., Gonz\u00e1lez-Mu\u00f1oz, S., L\u00f3pez-Isac, E., Nestares, T., and Bossini-Castillo, L. (2025). Single-Cell TCR Sequencing Uncovers Remodeling of the Immune Repertoire After a Short-Term Gluten-Free Diet in Pediatric Celiac Disease. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26188927"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110063","DOI":"10.1016\/j.jnutbio.2025.110063","article-title":"Immunomodulatory Effects of a Short-Term Gluten-Free Diet on Pediatric Celiac Disease: Findings from a Single-Cell Transcriptomics Study","volume":"146","author":"Carmona","year":"2025","journal-title":"J. Nutr. Biochem."},{"key":"ref_11","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_12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/MPG.0000000000001251","article-title":"Patients With Celiac Disease Reported Higher Consumption of Added Sugar and Total Fat Than Healthy Individuals","volume":"64","author":"Babio","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Masot, R., Labella, A., Baena-Garc\u00eda, L., Flor-Alemany, M., L\u00f3pez-Fr\u00edas, M., de la Higuera, M., Maldonado, J., and Nestares, T. (2022). Time Following a Gluten-Free Diet, Ultra-Processed Food Consumption and Quality of Life in Children with Celiac Disease. Appl. Sci., 12.","DOI":"10.3390\/app122211680"},{"key":"ref_14","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_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5223\/pghn.2017.20.1.1","article-title":"The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers","volume":"20","author":"Zeevenhooven","year":"2017","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1136\/bmj.320.7244.1240","article-title":"Establishing a Standard Definition for Child Overweight and Obesity Worldwide: International Survey","volume":"320","author":"Cole","year":"2000","journal-title":"BMJ"},{"key":"ref_17","unstructured":"(2025, September 30). Base de Datos BEDCA. Available online: https:\/\/www.bedca.net\/bdpub\/."},{"key":"ref_18","unstructured":"(2025, September 30). USDA FoodData Central, Available online: https:\/\/fdc.nal.usda.gov\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.appet.2016.11.006","article-title":"Consumption of Ultra-Processed Foods Predicts Diet Quality in Canada","volume":"108","author":"Moubarac","year":"2017","journal-title":"Appetite"},{"key":"ref_20","unstructured":"(2019). Ultra-Processed Food and Drink Products in Latin America: Trends, Impact on Obesity, Policy Implications, Pan American Health Organization."},{"key":"ref_21","unstructured":"(2015). FAO Guidelines on the Collection of Information on Food Processing Through Food Consumption Surveys, Food and Agriculture Organization of the United Nations."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/obr.12107","article-title":"Ultra-Processed Products Are Becoming Dominant in the Global Food System","volume":"14","author":"Monteiro","year":"2013","journal-title":"Obes. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1079\/PHN2004556","article-title":"Food, Youth and the Mediterranean Diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in Children and Adolescents","volume":"7","author":"Ribas","year":"2004","journal-title":"Public Health Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez, M.P., Ballestero-Fern\u00e1ndez, C., Fajardo, V., Ach\u00f3n, M., Garc\u00eda-Gonz\u00e1lez, \u00c1., Alonso-Aperte, E., and \u00dabeda, N. (2022). Gluten-Free Product Contribution to Energy and Macronutrient Intakes in Spanish Children and Adolescents with Celiac Disease. Foods, 11.","DOI":"10.3390\/foods11233790"},{"key":"ref_25","unstructured":"Samaniego Vaesken, M.d.L., \u00dabeda Mart\u00edn, N., Mart\u00ednez, M., Ach\u00f3n y Tu\u00f1\u00f3n, M., Alonso Aperte, E., Gonz\u00e1lez Gonz\u00e1lez, M.P., and Fajardo Mart\u00edn, V. (2019). Base de Datos de Composici\u00f3n de Alimentos Sin Gluten Certificados (SINGLUTEN-2019), Universidad San Pablo-CEU."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hysa, E., Gotelli, E., Campitiello, R., Paolino, S., Pizzorni, C., Casabella, A., Sulli, A., Smith, V., and Cutolo, M. (2024). Vitamin D and Muscle Status in Inflammatory and Autoimmune Rheumatic Diseases: An Update. Nutrients, 16.","DOI":"10.3390\/nu16142329"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1080\/09637486.2020.1734545","article-title":"Folate Content of Gluten-Free Food Purchases and Dietary Intake Are Low in Children with Coeliac Disease","volume":"71","author":"Cyrkot","year":"2020","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/jhn.12125","article-title":"Nutrient Intake in Adolescent Girls and Boys Diagnosed with Coeliac Disease at an Early Age Is Mostly Comparable to Their Non-Coeliac Contemporaries","volume":"27","author":"Kautto","year":"2014","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_29","unstructured":"Ortega, R.M., Requejo, A.M., Navia, B., L\u00f3pez-Sobaler, A.M., and Aparicio, A. (2019). Ingestas Diarias Recomendadas de Energ\u00eda y Nutrientes para la Poblaci\u00f3n Espa\u00f1ola, Departamento de Nutrici\u00f3n, Universidad Complutense de Madrid."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3109\/07853890.2013.849383","article-title":"Appropriate Nutrient Supplementation in Celiac Disease","volume":"45","author":"Caruso","year":"2013","journal-title":"Ann. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO Growth Reference for School-Aged Children and Adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Nestares, T., Mart\u00edn-Masot, R., de Teresa, C., Bonillo, R., Maldonado, J., Flor-Alemany, M., and Aparicio, V.A. (2021). Influence of Mediterranean Diet Adherence and Physical Activity on Bone Health in Celiac Children on a Gluten-Free Diet. Nutrients, 13.","DOI":"10.3390\/nu13051636"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2173\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:16:10Z","timestamp":1783325770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":32,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nu18132173"],"URL":"https:\/\/doi.org\/10.3390\/nu18132173","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]}}}