Background: Adherence to a gluten-free diet (GFD) is currently the only effective treatment for coeliac disease (CD). However, strict adherence does not necessarily ensure a nutritionally balanced diet. Adults with CD frequently consume processed gluten-free products with heterogeneous nutritional profiles, while factors influencing overall dietary quality remain insufficiently understood. In particular, the role of disease-related nutritional knowledge and socioeconomic determinants has received limited attention.
Objective: To investigate the association between coeliac disease-related nutritional knowledge and the quality of the gluten-free diet in adults with CD, and to explore the influence of educational level, socioeconomic status, and other patient characteristics on nutritional knowledge and dietary quality.
Methods: This ongoing, cross-sectional, observational study will recruit adults with biopsy- and/or serology-confirmed coeliac disease through the Celiac Association of Navarra (Spain). Participants will complete a structured questionnaire including sociodemographic and clinical characteristics, nutritional knowledge, dietary habits, and validated measures of quality of life. GFD quality will be assessed using dietary indicators based on current nutritional recommendations, together with food-processing classification systems. Multivariable regression analyses will be used to examine associations between nutritional knowledge, dietary quality, quality of life, and relevant explanatory variables.
Conclusion: This study addresses an important gap in understanding the determinants of dietary quality among adults with CD. By identifying potentially modifiable factors associated with healthier gluten-free dietary patterns, the findings are expected to inform future nutrition education strategies and support more personalised dietary management in routine clinical practice.