Gluten-free food insecurity is associated with reduced diet quality and ultra-processed food intake in youth with celiac disease.

BACKGROUND: Celiac disease (CD) is an autoimmune disease that requires lifelong adherence to a gluten-free diet (GFD). It is unknown whether GF-food insecurity (GF-FI) impacts diet quality (DQ) in CD youth. The study aim was to examine DQ and ultra-processed GF-food intake in GF-FI and GF-food secure (GF-FS) households and associations with parental nutrition literacy (NL) and the food environment (internal/external) in CD youth. METHODS: This cross-sectional study evaluated household GF-FS (2-item Hunger Vital Sign™, Six-Item Short Form Household FS Survey Module), parental nutrition literacy (NL Assessment Instrument), food environment (Perceived Nutrition Environment Measures Survey) and DQ (Healthy Eating Index-Canadian) in children (2-18 yrs; n = 59) with CD. Three-day food intake was analyzed for DQ, macro-and-micronutrient, gluten and ultra-processed GF-food intake. RESULTS: GF-FI was identified in 32.2 % of households (∼26% high-very high GF-FI). Lower income (<100K $CAD) was prevalent in GF-FI households. No significant differences in child sociodemographic/anthropometric (age, wt, wt-z, height, height-z), clinical (age at diagnosis, CD duration) or parent sociodemographic variables (age, education, ethnicity) were observed between GF-FI versus GF-FS households (P > 0.05). Children (98.4%) had DQ scores indicative of poor-needs improvement. GF-FS households had higher DQ (P = 0.004) and ultra-processed GF-food intake and lower GF-processed (GF-PF) food intake than children with CD in GF-FI households (P < 0.05), particularly in high-to-very high GF-FI households. Over 97% of families indicated high GF-food costs. CONCLUSIONS: GF-FI in households with CD youth is associated with significant reductions in DQ, increased GF-PF and decreased GF-UPF intake, particularly in high-to-very high GF-FI households.