Feeding Beyond Diagnosis: Parental Beliefs and Dietary Practices Among Children at Familial Risk for Celiac Disease

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Abstract
Background/Objectives: Coeliac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals with a higher prevalence among first-degree relatives. Despite its established hereditary risk, little is known about how parents with at least one child with CD perceive this risk in their unaffected children. This study examined parental perceptions and dietary practices regarding CD prevention in unaffected children. Methods: A cross-sectional mixed-methods study was conducted. The quantitative component consisted of an online questionnaire survey in parents in Greece. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression analysis. The qualitative component included semi-structured interviews with parents of children with CD and unaffected children in Greece. Data were analyzed using framework analysis. Results: Although parents demonstrated high awareness of genetic risk, this was not translated into preventive dietary modifications. Belief in the role of diet as preventive CD strategy emerged as the only significant predictor of dietary change. Diet was widely recognised as important for overall health or as a therapeutic regimen for children living with CD; however, it was not perceived as a preventive strategy for CD. Reported family barriers to adopting a healthy diet included financial constraints and limited guidance, whereas advice from healthcare professionals emerged as a key facilitator of dietary change. Conclusions: Although parents recognize the genetic risk to CD, they rarely implement dietary changes as CD preventive behavior for their unaffected children. These findings underscore the need for clearer dietary guidance and targeted professional support for families with children with CD and unaffected siblings.

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