REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
This article is part of the Research TopicEvolving Paradigms of Celiac Disease in Mediterranean CountriesView all articles
Gluten-related Nutritional Challenges in Pediatric Subjects: Treatment and Beyond
Provisionally accepted
Maria Elena Capra1Tullia Sguerso2Valentina Aliverti2Gianlorenzo Pisseri2Arianna Maria Bellani2Martina Berzieri2
Anna Giuseppina Montani2
Susanna Maria Roberta Esposito3*
Giacomo Biasucci2- 1Azienda Unita Sanitaria Locale di Piacenza, Piacenza, Italy
- 2Universita degli Studi di Parma, Parma, Italy
- 3Clinica Pediatrica, Ospedale Universitario di Parma, Parma, Italy
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Growing awareness of gluten-related disorders has led to a rising number of diagnoses of celiac disease (CD) and increasing adoption of the gluten-free diet (GFD), often without medical necessity. This narrative review summarizes current evidence on the main gluten-related conditions—CD, wheat allergy (WA), and non-celiac gluten sensitivity (NCGS)—and their nutritional implications, with particular focus on pediatric populations. Although these disorders share overlapping clinical features, they differ in pathogenesis, diagnostic criteria, and management. In CD, strict lifelong gluten exclusion remains essential for intestinal healing and symptom resolution, whereas in WA, wheat avoidance is the cornerstone of therapy. NCGS is characterized by gluten-related gastrointestinal and extra-intestinal symptoms in the absence of CD or WA, with notable clinical overlap with irritable bowel syndrome. Across all conditions, adherence to a GFD can lead to nutritional imbalances, including deficiencies in iron, folate, vitamin B12, vitamin D, calcium, zinc, and magnesium, as well as reduced fiber intake and unfavorable changes in gut microbiota. Overreliance on processed gluten-free foods may further increase cardiometabolic risks. In children, unmonitored GFDs may impair growth and neurodevelopment. Clinicians should ensure accurate differential diagnosis, provide nutritional counseling, and monitor long-term outcomes to balance the therapeutic benefits of GFD with potential risks.
Keywords: gluten, Celiac Disease, Wheat allergy, Non-celiac gluten sensitivity, nutrition, vitamin, Challenges
Received: 19 Sep 2025; Accepted: 28 Oct 2025.
Copyright: © 2025 Capra, Sguerso, Aliverti, Pisseri, Bellani, Berzieri, Montani, Esposito and Biasucci. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Susanna Maria Roberta Esposito, susanna.esposito@unimi.it
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.