The Influence of Dietary Compliance on Premenstrual Symptoms in Adolescents with Celiac Disease.

STUDY OBJECTIVE: Celiac disease (CD) may be associated with extraintestinal manifestations, including menstrual irregularities, particularly in adolescents with poor adherence to a gluten-free diet. Although premenstrual syndrome (PMS) is common during adolescence, its relationship with dietary adherence in adolescents with CD remains unclear. This study aimed to evaluate the frequency and severity of PMS in adolescents with CD and to assess its association with gluten-free diet adherence. METHODS: This cross-sectional study included female adolescents with biopsy-confirmed CD (n=50) and healthy controls (n=42), both with regular menstrual cycles. PMS was assessed using the Premenstrual Symptoms Screening Scale (PMSS), with a score ≥110 indicating PMS. Dietary adherence was evaluated through three methods: serum anti-tissue transglutaminase IgA (TGA-IgA) levels, self-reported compliance, and prospective three-day dietary records reviewed by a clinical dietitian. Group comparisons were conducted to assess PMS prevalence and subscale scores. RESULTS: While overall PMS prevalence did not differ significantly between CD and control groups (p=0.384), CD patients adhering to a gluten-free diet exhibited significantly lower PMSS scores compared to non-compliant patients and controls (groups based on serology p=0.036; self-reported compliance p=0.016; dietitian assessment p=0.001, respectively). Non-compliant patients reported more severe symptoms in domains related to depression, pain, sleep, and concentration. CONCLUSION: Dietary non-compliance in adolescents with CD is associated with increased severity of PMS symptoms. These findings highlight the need for comprehensive dietary and menstrual health evaluation in CD management and suggest that nutritional interventions may offer a therapeutic avenue for PMS symptom relief.