Background: High consumption of ultra-processed foods (UPF), industrially formulated with additives like artificial colors, flavors, emulsifiers, and thickeners, has been linked to obesity and metabolic syndrome. Children with celiac disease (CeD) may be particularly susceptible given gluten-free alternatives often require additional processing.
Objective: To examine UPF intake in adolescents with CeD and its association with body composition.
Methods: Adolescents (12–18 years) with biopsy-confirmed CeD following a gluten-free diet (GFD) for >6 months were recruited from Boston Children's Hospital (May 2025–July 2026). Participants completed a 24-hour dietary recall, bioelectrical impedance measurements, and questionnaires. Foods were classified using the NOVA system to calculate percentage of calories from UPF. Linear regression was used to assess the association between UPF intake and fat mass, adjusting for sex, age, race, and food security. Differences between the lowest and highest UPF intake tertiles were assessed using Welch’s t-test for continuous variables and Fisher’s exact test for categorical variables.
Results: Seventy-five participants (49 female) were included. Mean UPF intake was 65.1% of calories (SD 18.6%; range 23–100%). Higher UPF intake was not associated with increased fat mass after adjustment (β = 5.4, p = 0.22), and mean fat mass did not differ between the lowest and highest UPF intake tertiles (26.2% vs. 26.6%, p = 0.86). Gluten was identified in five recalls despite participants reporting no or rare (<1×/month) gluten exposure; all had followed a GFD for >2 years. Gluten exposure was more common in participants without dietitian education compared to those with (14.3% vs. 2.1%, p = 0.061).
Conclusion: UPF intake in this pediatric CeD cohort was similar to national averages and was not associated with fat mass, suggesting the GFD does not increase UPF consumption. Accidental gluten exposure remained common, particularly without dietitian education, underscoring the importance of dietitians in CeD management.