Background: The gluten-free diet is the only treatment for celiac disease, yet the high cost of gluten-free foods may contribute to food insecurity and create barriers to adherence. The Celiac Disease Food Insecurity Resource Network (CD-FIRN) was established to connect food-insecure households with medically necessary gluten-free food assistance through partnerships with medical centers across the United States.
Methods: 33 pediatric and adult medical centers were enrolled in CD-FIRN and implemented food insecurity screening in their celiac disease patients using the validated Hunger Vital Sign™. Patients screening positive were referred to the program and received monthly shipments of gluten-free pantry staples for six months. Program evaluation surveys were administered monthly throughout the program. Descriptive statistics were used to summarize participant characteristics and program outcomes.
Results: A total of 249 households enrolled in CD-FIRN, and 142 completed the final survey (57.0%). Participants were represented across 27 U.S. states, and 32.8% identified with racial or ethnic minority groups. 69% reported that food cost influenced meal planning, 74% reported that dietary restrictions influenced meal planning, 25% participated in the Supplemental Nutrition Assistance Program, and 11% participated in the Special Supplemental Nutrition Program for Women, Infants, and Children. 99.3% of participants reported being satisfied or very satisfied with the monthly food boxes, and 93.0% rated food quality as excellent or very good. Qualitative feedback highlighted improved access to gluten-free foods, reduced financial strain, increased variety, and greater confidence maintaining the gluten-free diet.
Conclusions: CD-FIRN demonstrates the feasibility of integrating standardized food insecurity screening and referral into celiac disease care while providing medically necessary gluten-free food assistance to households experiencing food insecurity. This model may help reduce financial barriers to treatment and improve access to the gluten-free diet. Future studies should evaluate the impact of this approach on food security, dietary adherence, and clinical outcomes.