Wieser, HerbertRuiz Carnicer, ÁngelaSegura Montero, VerónicaComino Montilla, Isabel MaríaSousa Martín, Carolina2022-01-192022-01-192021Wieser, H., Ruiz Carnicer, Á., Segura Montero, V., Comino Montilla, I.M. y Sousa Martín, C. (2021). Challenges of monitoring the gluten-free diet adherence in the management and follow-up of patients with celiac disease. Nutrients, 13 (7), 2274.2072-6643https://hdl.handle.net/11441/129001Celiac disease (CD) is a chronic gluten-responsive immune mediated enteropathy and is treated with a gluten-free diet (GFD). However, a strict diet for life is not easy due to the ubiquitous nature of gluten. This review aims at examining available evidence on the degree of adherence to a GFD, the methods to assess it, and the barriers to its implementation. The methods for monitoring the adherence to a GFD are comprised of a dietary questionnaire, celiac serology, or clinical symptoms; however, none of these methods generate either a direct or an accurate measure of dietary adherence. A promising advancement is the development of tests that measure gluten immunogenic peptides in stools and urine. Causes of adherence/non-adherence to a GFD are nu-merous and multifactorial. Inadvertent dietary non-adherence is more frequent than intentional non-adherence. Cross-contamination of gluten-free products with gluten is a major cause of inadvertent non-adherence, while the limited availability, high costs, and poor quality of certified gluten-free products are responsible for intentionally breaking a GFD. Therefore, several studies in the last decade have indicated that many patients with CD who follow a GFD still have difficulty controlling their diet and, therefore, regularly consume enough gluten to trigger symptoms and damage the small intestine.application/pdf22 p.engAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Celiac diseaseDietary adherenceGluten-free dietPatients with CDSymptomsinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccesshttps://doi.org/10.3390/nu13072274