Celiac disease (CD) is a chronic autoimmune disorder that affects the small intestine in genetically predisposed individuals. Previous studies have investigated the potential link between CD and cardiovascular disease (CVD); however, the findings have been inconsistent. We aimed to provide an updated review of the literature on the association between CD and CVD. PubMed was searched from inception to January 2023 using keywords including CD, cardiovascular disease, coronary artery disease, cardiac arrhythmia, heart failure, cardiomyopathy, and myocarditis. We summarized the results of the studies, including meta-analyses and original investigations, and presented them according to the different forms of CVD. Meta-analyses published in 2015 provided mixed results regarding the relationship between CD and CVD. However, subsequent original investigations have shed new light on this association. Recent studies indicate that individuals with CD are at a higher risk of developing overall CVD, including an increased risk of myocardial infarction and atrial fibrillation. However, the link between CD and stroke is less established. Further research is needed to determine the link between CD and other cardiac arrhythmias, such as ventricular arrhythmia. Moreover, the relationship between CD and cardiomyopathy or heart failure, as well as myopericarditis, remains ambiguous. CD patients have a lower prevalence of traditional cardiac risk factors, such as smoking, hypertension, hyperlipidemia, and obesity. Therefore, it is important to discover strategies to identify patients at risk and reduce the risk of CVD in CD populations. Lastly, it is unclear whether adherence to a gluten-free diet can diminish or increase the risk of CVD among individuals with CD, necessitating further research in this area. To fully comprehend the correlation between CD and CVD and to determine the optimal prevention strategies for CVD in individuals with CD, additional research is necessary.

A gluten-free diet (GFD), which is the only treatment for celiac disease (CeD), is challenging and associated with higher levels of anxiety, disordered eating, and lower quality of life (QOL). We examined various demographic and health factors associated with social anxiety, eating attitudes and behaviors, and QOL. Demographics and health characteristics, QOL, eating attitudes and behaviors, and social anxiety of adults with CeD were acquired using validated measures. The mean scores for QOL, SAQ, and CDFAB were compared across various demographic groups using the Z statistical test. The mean QOL score was 57.8, which is in the moderate range. The social anxiety mean scores were high: 78.82, with 9% meeting the clinical cutoff for social anxiety disorder. Those on a GFD for a short duration had significantly higher SAQ scores (worse anxiety), higher CDFAB scores (worse eating attitudes and behavior), and lower QOL scores. Those aged 23–35 years had lower QOL scores (p < 0.003) and higher SAQ scores (p < 0.003). Being single (p < 0.001) and female (p = 0.026) were associated with higher SAQ scores. These findings suggest that the development of targeted interventions to maximize QOL and healthy eating behaviors as well as to minimize anxiety is imperative for some adults with CeD.

Background: Coeliac disease (CeD) is a type of enteropathy characterised by an immune‐mediated reaction to ingested gluten, resulting in impaired absorption of nutrients and symptoms such as bloating, abdominal cramping and diarrhoea. Currently, the only treatment for CeD is adherence to a gluten‐free diet (GFD). The latest draft guidance from the US Food and Drug Administration recommends that dietitians experienced in CeD management evaluate patients during the screening and treatment period of CeD clinical trials to assess adherence to a GFD. However, there are currently no standardised guidelines on dietary assessment of patients with CeD on a GFD and there is a lack of widespread availability of expertise in this field.Methods: Based on the findings of a literature review conducted between April and September 2023, this article provides an overview of key points to consider in the nutritional and dietary assessment of patients with CeD who are following a GFD, with particular focus on the clinical trial setting.Results: Based on a consensus from dietitians and gastroenterologists experienced in treating patients with CeD, we present specific recommendations for registered dietitians who manage patients with CeD. We also describe the development of a simplified tool for assessment of adherence to a GFD, the Gluten‐Free Adherence Survey, based on these recommendations.Conclusions: These guidelines cover nutritional and dietary assessment of patients with CeD, physical assessments, intake of oats, environmental considerations and the disease burden.

Background: The only treatment for Celiac Disease (CeD), which affects about 1% of the population, is a gluten-free diet (GFD). Studies have indicated an association between the GFD, a diminished quality of life (QOL), and maladaptive eating patterns. This study aims to explore food avoidance behaviors in adults with CeD. Methods: This cross-sectional study assessed 50 adults with biopsy-confirmed CeD who completed validated surveys evaluating demographics, psychological factors, QOL, eating pathology, and food avoidance. Results: Overall CDQOL scores were good (mean: 62.7 out of 100). However, 58.0% of the participants self-elected to avoid one or more additional foods without diagnosed allergies or intolerances. Those avoiding one or more other foods had lower QOL scores (57.4 (23.2) vs. 70.2 (15.9)) compared to those only avoiding gluten (p = 0.034). The mean depression score (CESD) for the group avoiding foods beyond gluten was in the depressive range, unlike those avoiding only gluten (16.0 (4.9) vs. 13.6 (4.0), p = 0.078), with 77% of those avoiding more than gluten scoring above the CESD cut-off point of 15, indicating clinical depression. Conclusions: Over half of participants (58%) reported avoiding additional foods beyond the GFD, a behavior associated with decreased QOL and increased depression.

Background: Shared fryers are commonly perceived as a high-risk source of gluten cross-contact for individuals with celiac disease (CeD), leading to widespread avoidance of foods such as French fries and tortilla chips. However, limited real-world data exist evaluating gluten concentrations in foods prepared in shared fryers under routine food service conditions. Because long-term health outcomes in celiac disease depend on minimizing cumulative dietary gluten exposure and intestinal injury is dose-dependent, characterizing gluten contamination from common dining practices has important implications for nutritional management and disease counseling. Objective: The aim of this study was to quantify gluten concentrations in naturally gluten-free (GF) foods prepared in shared fryers across U.S. food service establishments and to evaluate how fryer management practices, restaurant type, and geographic distribution influence gluten content. Methods: This cross-sectional observational study analyzed gluten concentrations in 98 samples of French fries (n = 55) and tortilla chips (n = 43) collected from fast food, fast casual, casual dining, and fine dining establishments, cafés, and other food service settings across multiple U.S. states. All samples were naturally GF prior to frying and prepared in fryers shared with gluten-containing foods. Gluten concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Recorded variables included sample type, restaurant type, state location, and fryer oil change frequency (daily, weekly, or unknown). In accordance with the U.S. Food and Drug Administration (FDA) GF labeling standard, foods containing <20 ppm gluten were considered GF, while values ≥20 ppm were classified as exceeding the GF threshold. Values <5 ppm were considered below the assay’s limit of quantification (LOQ). Results: Of the 98 samples analyzed, six (6.1%) exceeded the FDA GF threshold of 20 ppm. The majority of samples (84/98, 85.7%) measured below the assay’s lower LOQ (<5 ppm gluten). All 43 tortilla chip samples tested <5 ppm. Among samples from fast food establishments, 9/12 (75.0%) measured <5 ppm, 2/12 (16.7%) measured 5–20 ppm, and 1/12 (8.3%) exceeded 20 ppm. Among samples from fast casual establishments, 13/15 (86.7%) measured <5 ppm, 1/15 (6.7%) measured 5–20 ppm, and 1/15 (6.7%) exceeded 20 ppm. Greater variability was observed in casual dining establishments, including samples exceeding 20 ppm. All samples collected from establishments reporting daily oil changes measured <20 ppm, while samples from establishments reporting weekly oil changes demonstrated higher and more variable gluten concentrations, including values greater than 20 ppm. Conclusions: In this multi-site observational study, shared fryers were not uniformly associated with meaningful gluten cross-contact. Gluten concentrations varied by food service context and fryer management practices, with consistently low or below-LOQ gluten levels observed in establishments reporting daily fryer oil replacement, and greater variability observed in settings with less frequent oil changes. These results indicate that shared fryers are not inherently high-risk sources of gluten cross-contact and highlight daily fryer oil replacement as a key operational factor significantly associated with lower measured gluten levels. These findings have direct nutritional implications. Estimating gluten concentrations in shared-fryer environments allows for more accurate assessment of potential daily gluten intake, which is the key determinant of mucosal healing, serologic normalization, and long-term nutritional and health outcomes in individuals with celiac disease.