Gluten-Free Food Insecurity is associated with reduced Diet Quality and ultra-processed food intake in youth with Celiac Disease.

• A total 32% households with children with CD reported gluten-free food insecurity. • Over 97% of families indicated high gluten-free food costs. • Poor child diet quality/lower lower-ultra-processed food higher gluten free-processed food intake occurred with food insecurity. • Lack of food policy programs aimed at the gluten free diet in children may contribute to unhealthy diets for children with CD on the GFD. Celiac Disease (CD) is an autoimmune disease that requires lifelong adherence to a gluten-free diet (GFD). It is unknown whether GF-food insecurity (GF-FI) impacts diet quality (DQ) in CD youth. The study aim was to examine DQ and ultra-processed GF-food intake in GF-FI and GF-food secure (GF-FS) households and associations with parental nutrition literacy (NL) and the food environment (internal/external) in CD youth. This cross-sectional study evaluated household GF-FS (2-item Hunger Vital Sign™, Six-Item Short Form Household FS Survey Module), parental nutrition literacy (NL Assessment Instrument), food environment (Perceived Nutrition Environment Measures Survey) and DQ (Healthy Eating Index) in children (2-18 yrs; n=59) with CD. Three-day food intake was analyzed for DQ, macro-and-micronutrient, gluten and ultra-processed GF-food intake. GF-FI was identified in 32.2 % of households (∼26% low-very low GF-FS). Lower income (0.05). Children (98.4%) had DQ scores indicative of poor-needs improvement. GF-FS households had higher DQ (p=0.004) and ultra-processed GF-food intake and lower GF-processed (GF-PF) food intake than children with CD in GF-FI households (p<0.05), particularly in high-to-very high GF-FI households. Over 97% of families indicated high GF-food costs. GF-FI in households with CD youth is associated with significant reductions in DQ, increased GF-PF and decreased GF-UPF intake, particularly in high-to-very high GF-FS households.