Background/Objectives: The Mediterranean diet (MD) reduces cardiovascular risk, which is higher in celiac disease (CD). We aimed to investigate adherence to the MD in newly diagnosed CD patients, CD patients on a gluten-free diet (GFD), and in a non-celiac control group. Additionally, we aimed to establish an association between GFD and MD adherence. Methods: In this nested, cross-sectional Hungarian study, MD adherence was assessed using the Mediterranean Diet Score (MDS), and GFD adherence was assessed using the Standardized Dietitian Evaluation (SDE). Results: A total of 215 subjects were enrolled, 128 of which were CD patients on a GFD for a minimum of 1 year, 24 were newly diagnosed CD patients, and 63 were non-CD healthy control subjects. Although the control subjects had a higher mean MDS, the groups did not differ statistically significantly from each other (CD on GFD: 5.55 ± 1.57, newly diagnosed CD: 5.35 ± 1.81, controls: 6.05 ± 1.73; p > 0.05)—all groups had suboptimal scores. Both CD groups consumed fewer whole grains than the controls (p < 0.001). Adequate GFD adherence was associated with higher MDS (5.62 ± 1.54 vs. 4.71 ± 1.21, respectively; p = 0.009). Conclusions: Our study highlights the low adherence to MD in celiac patients with insufficient consumption of whole grains. Adherence to GFD is associated with better MD adherence, which underlines the role of dietary education during follow-up. Targeted nutritional counseling could improve the quality of diet in CD patients to reduce cardiovascular risk.

Introduction Coeliac disease (CD) affects 1% of the population worldwide. The only available evidence-based treatment is a strict gluten-free diet (GFD), which can readily lead to weight gain and unfavourable metabolic changes (eg, dyslipidaemia, fatty liver disease and insulin resistance) if followed without adequate dietary control. That can lead to increased cardiovascular risk (CV). We planned a randomised controlled trial to test the effect of a group-based, structured, 1-year, advanced dietary education, per the proposal of a Mediterranean diet vs standard of care, regarding the most relevant CV risk factors (eg, metabolic parameters and body composition) in CD patients. Methods and analysis Randomisation will occur after the baseline dietary education and interview in a 1:1 allocation ratio. Outcomes include anthropometric parameters (body composition analysis including weight, Body Mass Index, fat mass, per cent body fat, skeletal muscle mass, visceral fat area and total body water) and CV risk-related metabolic parameters (eg, lipid profile, homocysteine, fasting glucose, haemoglobin A1c, Homeostatic Model Assessment Index, metabolic hormones, waist circumference, blood pressure, liver function tests, liver steatosis rate and diet composition). In this study, we aim to draw attention to a new aspect regarding managing CD: dietary education can lead to a better quality of the GFD, thereby reducing the risk of potential metabolic and CV complications. Ethics and dissemination The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals. Trial registration number NCT05530070

Background: Celiac disease (CD) is a chronic immune-mediated enteropathy that is treated exclusively with a lifelong gluten-free diet (GFD). Hepatic involvement, including hepatic steatosis (HS), is common in both newly diagnosed and long-term GFD-treated CD patients. Limited data exist regarding HS prevalence and risk factors in CD, and the effects of dietary patterns, including GFD and the Mediterranean diet (MD), remain unclear. Objective: This study investigated the prevalence and severity of HS in newly diagnosed, pre-GFD and GFD-treated CD patients compared to non-celiac control subjects, while assessing the influence of dietary adherence. Methods: In a nested cross-sectional study within the ARCTIC trial (NCT05530070), 290 Hungarian adults were enrolled (60 pre-GFD CD, 156 CD on GFD, and 74 control subjects). HS was assessed by ultrasonography, and dietary adherence was evaluated using the Standardized Dietitian Evaluation and Mediterranean Diet Score (MDS). Binary regression models were applied to identify predictors of HS. Results: HS was diagnosed in 34% of participants, most frequently in pre-GFD CD patients. BMI was the strongest predictor of HS both overall and within the CD cohort (OR = 1.27; 95% CI: 1.16, 1.42; p < 0.001). Neither adherence to GFD nor overall MD adherence significantly influenced the prevalence of HS. Severity of HS correlated with higher BMI, older age, and diabetes prevalence, while individual MD components, including olive oil consumption, were associated with milder HS. Conclusions: HS is more prevalent in CD patients, particularly pre-GFD patients, and is strongly associated with BMI. While overall dietary patterns did not significantly impact HS, certain diet components may modulate severity.

Az irritábilis bél szindróma az agy-bél tengely zavarával járó betegség, amely hasi fájdalommal és a széklet változásával jelentkezik. A dietetikai tanácsadás kiemelten fontos, mivel az étrendet egyénileg kell igazítani a betegek tüneteihez. A betegség kezelésében többféle népszerű diéta felmerült, de jelenleg csak a FODMAP-szegény étrend kedvező hatását támasztják alá tudományos bizonyítékok. A gluténmentes diéta ellenben nem javasolt, mivel valószínűleg a tüneteket nem a glutén, hanem a búza és a benne lévő fruktánok csökkentése mérsékelheti, így felesleges korlátozást jelent a betegek számára. Az eliminációs diéták hosszú távon csak bizonyított élelmiszer-intolerancia esetén ndokoltak, szakértő dietetikus felügyeletével. Az élelmi rostok közül a vízben oldódó rostok kedvezően hatnak, míg a nem oldható rostok fokozhatják a tüneteket. A megfelelő folyadékbevitel szükséges a rostok kedvező hatásainak eléréséhez. A probiotikumok közül bizonyos törzsek, egyes betegcsoportokban képesek csökkenteni a tüneteket. A prebiotikumok alkalmazása viszont nem ajánlott, mivel kedvező hatásuk nem bizonyított, ugyanakkor egyes prebiotikumok akár fokozhatják is a tüneteket. Magyarországon 2024 októberében új szakmai irányelv jelent meg az irritábilis bél szindróma kezelésére, amely hangsúlyozza a dietetikai tanácsadás szerepét és segít eligazodni a különböző terápiás lehetőségek között.