Journals / İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi / 2026 / Cilt: 11 Sayı: 2

COVID-19 Anxiety and Health-Related Factors Associated with Gluten-Free Diet Adherence in Celiac Disease Patients

Çölyak Hastalığında Glutensiz Diyete Bağlılıkla İlişkili COVID-19 Anksiyetesi ve Sağlıkla İlgili Faktörler

Gülşah Kaner(İZMİR KATİP ÇELEBİ ÜNİVERSİTESİ)0000-0001-5882-6049
Çağla Ayer(İZMİR KATİP ÇELEBİ ÜNİVERSİTESİ)0000-0001-6124-7339
İrem Meral(IZMIR KATIP CELEBI UNIVERSITY)0000-0002-7741-2324
Selcan Duvar Girgin(İZMİR KATİP ÇELEBİ ÜNİVERSİTESİ)0009-0008-0564-141X
Pages
267–273
Publication Date
2026-05-31
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

However, limited access to professional support and gluten-free foods highlights the need for improved healthcare access and dietary resources during public health crises.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: Celiac disease (CD) is a chronic autoimmune disorder requiring lifelong adherence to a gluten-free diet (GFD).
📊
Key Findings & Data:The COVID-19 pandemic has significantly impacted the lifestyle, psychological well-being, and dietary management of individuals with chronic illnesses, including CD.
💡
Conclusion & Impact:However, limited access to professional support and gluten-free foods highlights the need for improved healthcare access and dietary resources during public health crises.
🔬Design:Survey & Empirical Study
📍Scope:Comprehensive Sample
⚙️Variables:çölyak hastalığı · Covıd-19 anksiyetesi · glutensiz diyet

Abstract

Objective: Celiac disease (CD) is a chronic autoimmune disorder requiring lifelong adherence to a gluten-free diet (GFD). The COVID-19 pandemic has significantly impacted the lifestyle, psychological well-being, and dietary management of individuals with chronic illnesses, including CD. This study aimed to examine the relationship between COVID-19-related anxiety and adherence to a GFD among adults with CD, and to evaluate changes in dietary behaviors, access to gluten-free products, and professional dietary support during the pandemic. Material and Methods: A cross-sectional study was conducted among adults with physician-diagnosed celiac disease in Türkiye. Participants completed an online questionnaire assessing demographic characteristics, CD-related symptoms, comorbidities, GFD adherence, dietitian consultation, and COVID-19-related anxiety. Results: A significant association was found between COVID-19-related anxiety and greater adherence to a GFD (p=0.020), as well as with specific symptoms such as diarrhea (p=0.032), and comorbidities like thyroid disease (p=0.034) and bone-joint disease (p=0.019). Despite 54% of participants never having received dietitian counseling, and only 15% continuing dietary support during the pandemic, 56.5% reported GFD adherence. Major barriers included product inaccessibility and cost. Although probiotic/supplement use increased slightly, no significant changes in meal frequency, preparation habits, or physical activity were observed. Conclusion: COVID-19-related anxiety appears to have motivated stronger dietary adherence among individuals with celiac disease. However, limited access to professional support and gluten-free foods highlights the need for improved healthcare access and dietary resources during public health crises.

Özet

Amaç: Çölyak hastalığı (ÇH), glutensiz diyete (GD) ömür boyu bağlılık gerektiren kronik bir otoimmün hastalıktır. COVID-19 salgını, ÇH dahil kronik hastalıkları olan bireylerin yaşam tarzını, psikolojik refahını ve diyet yönetimini önemli ölçüde etkilemiştir. Bu çalışmanın amacı, ÇH'li yetişkinler arasında COVID-19 ile ilişkili anksiyete ve GD'ye bağlılık arasındaki ilişkiyi incelemek ve pandemi sırasında diyet davranışlarındaki değişiklikleri, glutensiz ürünlere erişimi ve profesyonel diyet desteğini değerlendirmektir. Gereç ve Yöntem: Türkiye'de doktor tanılı çölyak hastalığı olan yetişkinler arasında kesitsel bir çalışma gerçekleştirilmiştir. Katılımcılar demografik özellikleri, ÇH ile ilişkili semptomları, komorbiditeleri, GFD bağlılığını, diyetisyen konsültasyonunu ve COVID-19 ile ilişkili anksiyeteyi değerlendiren çevrimiçi bir anket formu uygulanmıştır. Bulgular: COVID-19 ile ilişkili anksiyete ile GD'ye daha fazla bağlılık (p=0,020) arasında ve ayrıca diyare (p=0,032) gibi spesifik semptomlar ve tiroid hastalığı (p=0,034) ve kemik-eklem hastalığı (p=0,019) gibi komorbiditeler arasında anlamlı bir ilişki bulunmuştur. Katılımcıların %54'ünün hiç diyetisyen danışmanlığı almamış olmasına ve yalnızca %15'inin pandemi sırasında diyet desteğine devam etmesine rağmen, %56,5'i GD'ye uyduğunu bildirmiştir. Başlıca engeller arasında ürünlere erişilememesi ve maliyet yer almaktadır. Probiyotik/takviye kullanımı hafifçe artmış olsa da öğün sıklığı, hazırlama alışkanlıkları veya fiziksel aktivitede önemli bir değişiklik gözlenmemiştir. Sonuç: COVID-19 ile ilgili kaygı, çölyak hastalığı olan bireyler arasında diyete daha güçlü bağlılığı motive etmiş gibi görünmektedir. Bununla birlikte, profesyonel desteğe ve glutensiz besinlere sınırlı erişim, halk sağlığı krizleri sırasında sağlık hizmetlerine erişimin ve diyet kaynaklarının iyileştirilmesi ihtiyacını vurgulamaktadır.

🔖

Cite This Article

Kaner, G., Ayer, Ç., Meral, İ., Girgin, S. D. (2026). COVID-19 Anxiety and Health-Related Factors Associated with Gluten-Free Diet Adherence in Celiac Disease Patients. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, Cilt: 11 Sayı: 2, 267–273. https://doi.org/10.61399/ikcusbfd.1752561

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (26)

  1. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020 Feb 15;395(10223):470-473. DOI: 10.1016/S0140-6736(20)30185-9.
  2. Liu Y, Gu X, Li H, Zhang H, Xu J. Mechanisms of long COVID: An updated review. Chin Med J Pulm Crit Care Med. 2023 Dec 6;1(4):231-240. DOI: 10.1016/j.pccm.2023.10.003.
  3. Abadie V, Sollid LM, Barreiro LB, Jabri B. Integration of genetic and immunological insights into a model of celiac disease pathogenesis.Annu Rev Immunol. 2011;29:493-525. DOI: 10.1146/annurevimmunol-040210-092915.
  4. Gatti S, Rubio-Tapia A, Makharia G, Catassi C. Patient and community health global burden in a world with more celiac disease. Gastroenterology. 2024 Jun;167(1):23-33. DOI:10.1053/j.gastro.2024.01.035.
  5. Santacroce G, Lenti MV, Aronico N, Miceli E, Lovati E, Lucotti PC, et al. Impact of COVID-19 in immunosuppressive drug-naïve autoimmune disorders: Autoimmune gastritis, celiac disease, type 1diabetes, and autoimmune thyroid disease. Pediatr Allergy Immunol. 2022 Jan;33 Suppl 27(Suppl 27):105-107. DOIi:10.1111/pai.13646.
  6. Gasbarrini G, Dionisi T, Corazza GR, Aronico N, Cammarota G, Ianiro G, et al. COVID-19 in celiac disease: a multicentric retrospective cohort study. Eur Rev Med Pharmacol Sci. 2021 Jun;25(12):4400-4404. DOI: 10.26355/eurrev_202106_26150.
  7. Zhen J, Stefanolo JP, Temprano MP, Tedesco S, Seiler C, Caminero AF, et aI. The risk of contracting COVID-19 is not increased in patients with celiac disease. Clin Gastroenterol Hepatol. 2021 Feb;19(2):391-393. DOI: 10.1016/j.cgh.2020.10.009.
  8. Zou Y, Pan M, Zhou T, Yan L, Chen Y, Yun J, et al. Critical COVID-19, Victivallaceae abundance, and celiac disease: A mediation mendelian randomization study. PLoS One. 2024 May 3;19(5):e0301998. DOI: 10.1371/journal.pone.0301998.
  9. Elli L, Leffler D, Cellier C, Lebwohl B, Ciacci C, Schumann M, et al. Guidelines for best practices in monitoring established coeliac disease in adult patients. Nat Rev Gastroenterol Hepatol. 2024 Mar;21(3):198-215. DOI: 10.1038/s41575-023-00872-2.
  10. Samasca G, Lerner A, Girbovan A, Sur G, Lupan I, Makovicky P, et al. Challenges in gluten-free diet in coeliac disease: Prague consensus.Eur J Clin Invest. 2017 May;47(5):394-397. DOI: 10.1111/eci.12755.
  11. Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020 Mar;25(3):278-280. DOI: 10.1111/tmi.13383.
  12. Lamy E, Viegas C, Rocha A, Raquel Lucas M, Tavares S, Capela E Silva F, et al. Changes in food behavior during the first lockdown of COVID-19 pandemic: A multi-country study about changes in eating habits, motivations, and food-related behaviors. Food Qual Prefer. 2022 Jul;99:104559. DOI: 10.1016/j.foodqual.2022.104559.
  13. Knorr D, Khoo CSH COVID-19 and food: challenges and research needs. Front Nutr. 2020, Dec 3;7:598913 DOI:10.3389/fnut.2020.598913.
  14. Zhen J, Stefanolo JP, Temprano MP, Seiler CL, Caminero A, de- Madaria E, et al. Risk perception and knowledge of COVID-19 in patients with celiac disease. World J Gastroenterol. 2021 Mar 28;27(12):1213-1225. DOI: 10.3748/wjg.v27.i12.1213.
  15. Siniscalchi M, Zingone F, Savarino EV, D'Odorico A, Ciacci C. COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine. Dig Liver Dis. 2020 Oct;52(10):1071-1075. DOI: 10.1016/j.dld.2020.05.014.
  16. Gokden Y, Hot S, Adas M, Ogutmen Koc D, Atak S, Hot AB. Celiac disease and COVID-19 pandemic: should we worry? Acta Gastroenterol Belg. 2020 Oct-Dec;83(4):517-525.
  17. Uzunkol N. Effects of the COVID-19 pandemic on gluten-free diet compliance and quality of life in celiac patients [master’s thesis on the internet]. [Kayseri]: Erciyes University; 2023. [cited 2025 Sep 4]. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp.
  18. Bascuñán KA, Rodríguez JM, Osben C, Fernández A, Sepúlveda C, Araya M. Pandemic effects and gluten-free diet: an adherence and mental health problem. Nutrients. 2021 May 27;13(6):1822. DOI:10.3390/nu13061822.
  19. Möller SP, Apputhurai P, Tye-Din JA, Knowles SR. Quality of life in coeliac disease: relationship between psychosocial processes and quality of life in a sample of 1697 adults living with coeliac disease. J Psychosom Res. 2021 Dec;151:110652. DOI: 10.1016/j.jpsychores.
  20. Mehtab W, Agarwal H, Ghosh T, Chauhan A, Ahmed A, Singh A, et al. Patterns of practice in the diagnosis, dietary counselling and follow-up of patients with celiac disease- A patient-based survey. Indian J Gastroenterol. 2023 Feb;42(1):88-95. DOI: 10.1007/s12664-022-01296-7.
  21. Boutahar K, Ihbour S, Hadi K, Kaoutar K, Chetoui A, El Kardoudi A, et al. Anxiety and Associated Factors during the COVID-19 Pandemic Confinement in the Moroccan Adult Celiac Disease Population. Port J Public Health. 2023 Jan 16;40(3):163-171. DOI: 10.1159/000528164.
  22. Shahnazi H, Ahmadi-Livani M, Pahlavanzadeh B, Rajabi A, Hamrah MS, Charkazi A. Assessing preventive health behaviors from COVID-19: a cross sectional study with health belief model in Golestan Province, Northern of Iran. Infect Dis Poverty. 2020 Nov 17;9(1):157. DOI: 10.1186/s40249-020-00776-2.
  23. Husby S, Bai JC. Follow-up of celiac disease. Gastroenterol Clin North Am. 2019 Mar;48(1):127-136. DOI: 10.1016/j.gtc.2018.09.009.
  24. Trott N, Raju SA, Rej A, Hoffman O, Holland W, Bebb JR, et al. Longterm follow-up in patients with coeliac disease in the pandemic-era: a view from Sheffield the NHS England national centre for adult coeliac disease. Gastroenterol Hepatol Bed Bench. 2023;16(2):158-166.DOI: 10.22037/ghfbb.v16i2.2637.
  25. Mehtab W, Chauhan A, Agarwal A, Singh A, Rajput MS, Mohta S, et al. Impact of Corona Virus Disease 2019 pandemic on adherence to gluten-free diet in Indian patients with celiac disease. Indian J Gastroenterol. 2021 Dec;40(6):613-620. DOI: 10.1007/s12664-021-01213-4.
  26. Aydin AI, Baspinar B, Atak M, Demirtas Z, Oztas G, Ozyazicioglu N. Adherence to gluten-free diet and affecting factors in adolescents with celiac disease during the COVID-19. Int J Caring Sci. 2023;16(3):1091.