Factors associated with adherence to gluten-free diet among celiac patients in Palestine: A cross-sectional study

Celiac disease, an autoimmune disorder, mandates lifelong adherence to a strict gluten-free diet (GFD) as the sole treatment. In examining this imperative, a study was conducted to explore the degree of compliance with a GFD among adults with celiac disease in Palestine and how it relates to disease activity, mental health, and several sociodemographic factors.

Involving 137 individuals with celiac disease, the cross-sectional research gathered participants from various sources, including private and public healthcare facilities as well as community organizations. The study utilized multiple frameworks for measurement: disease activity was gauged through the Celiac Symptom Index (CSI) and mental health via the General Health Questionnaire (GHQ-12). Additionally, a specially designed structured questionnaire assessed knowledge, awareness, attitudes, and barriers, alongside adherence, which was evaluated through participants’ reported practices.

The participant cohort had an average age of 37.7 years, with females constituting 71% of the group. Analysis revealed diverse levels of dietary adherence: 36.5% of participants exhibited high adherence, 61.3% moderate adherence, and 2.2% low adherence to a GFD. Bivariate statistical analysis highlighted significant associations between adherence levels and factors such as symptom burden (CSI), mental health distress (GHQ-12), and subjective knowledge and attitudes towards GFD. Notably, barriers related to meal preparation and social contexts were also significant (P < 0.05).

Further multivariate analysis pinpointed a positive attitude towards a gluten-free diet as the most reliable independent predictor of adherence. The correlation with male gender was observed to be less consistent and weaker across different analyses. These findings emphasize the pivotal role of attitude in diet adherence and advocate for the creation of culturally tailored interventions to enhance adherence and ultimately patient outcomes in Palestinian individuals with celiac disease. [NPID: celiac, gluten, autoimmune, dietary adherence]

Year: 2026

Reference: Saed, L., Badrasawi, M., Braik, M., Dibas, A., Maqboul, M., Abdoh, Q., & Hattab, M. (2026). Factors associated with adherence to gluten-free diet among celiac patients in Palestine: A cross-sectional study. Scientific Reports. https://doi.org/10.1038/s41598-026-49948-4

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