Living Gluten-Free in Romania: A National Cross-Sectional Study of Dietary Adherence in Clinically Diagnosed and Self-Reported Cases.

Background/Objectives: A gluten-free diet (GFD) remains the only effective therapy for celiac disease (CD) and non-celiac gluten sensitivity (NCGS). Strict adherence is essential, yet it can impose considerable psychological, social, and financial burdens. This study investigated factors influencing GFD adherence, explored the perceived burden of this therapy, and examined differences between individuals with CD and NCGS. Methods: A cross-sectional anonymous questionnaire was completed by 681 Romanian citizens living in Romania with either a medically confirmed or a self-reported diagnosis of CD or NCGS. The survey assessed GFD adherence and its potential predictors, including gender, family history, comorbidities, diagnostic confirmation, and food security and perceived availability, as well as various psychological, social, and financial factors. Results: Participants with CD showed significantly higher GFD adherence than those with NCGS. Self-diagnosis was more common among NCGS respondents and was associated with poorer adherence, whereas a medically confirmed diagnosis predicted stricter adherence. Longer time since diagnosis, a greater perceived importance of a GFD, consistent label reading, as well as weight gain after starting a GFD were also positively associated with adherence. Although gluten-free (GF) food security has improved over time, cost remains a major barrier. Social activities negatively influenced adherence, reflecting the isolating effects of dietary restrictions. Nearly 25% of respondents reported a family history of gluten-related disorders (GRDs). Women-although more frequently affected by GRDs-exhibited levels of adherence similar to men. Comorbidities were common (33.9%), predominantly autoimmune diseases (56.3%), with autoimmune thyroiditis (32%) and lactose intolerance (19.2%) being the most frequent comorbidities. Conclusions: Diagnostic certainty, motivation, and practical barriers influence GFD adherence. Enhanced public awareness, clear labeling, improved GF food security, and financial support could facilitate sustained adherence and reduce psychosocial burden. To the author's knowledge, this is the first national study of its kind in Romania.