Table 1_Changes in gluten-free diet adherence and growth parameters among children with celiac disease during the COVID-19 pandemic.docx

Serological adherence was defined by a negative tTG-IgA result.</p>Results<p>At the beginning of the pandemic in March 2020, the mean duration of GFD was 3.9 ± 2.4 years. At the time of the survey, self-reported adherence was 67.9% (55/81), whereas serological adherence was 77.1% (54/70). During the pandemic, 49.4% of participants reported no change in dietary adherence, 33.3% reported increased adherence, and 17.3% reported decreased adherence.

Serological adherence differed significantly across the three longitudinal assessment periods (Cochran's Q = 31.818, p < 0.001). Compared with the pre-pandemic period (51.9%, 42/81), serological adherence was significantly higher during both the restriction period (82.7%, 67/81) and the post-pandemic period (76.5%, 62/81) (McNemar p < 0.001 for both comparisons), whereas no significant difference was observed between the restriction and post-pandemic periods (McNemar p = 0.227).

Serological adherence was associated with home-cooking and selected family and socioeconomic factors. Most participants (87.7%) reported difficulty accessing gluten-free products, mainly due to high cost and limited variety. No significant differences were observed in anthropometric measurements across the study periods.</p>Conclusion<p>Serological adherence was significantly higher during both the COVID-19 restriction and post-pandemic periods than during the pre-pandemic period, while no significant changes in anthropometric measurements were observed.</p>