Quality of life in adults with celiac disease in Spain over a decade

Celiac disease (CD) can significantly impair health-related quality of life (HRQOL), mainly due to persistent symptoms and the burden of a lifelong gluten-free diet (GFD). Evidence regarding changes in HRQOL in recent years is scarce despite advances in diagnosis and dietary support. We conducted a comparative cross-sectional study using two large national cross-sectional samples of Spanish adults with CD assessed in 2014 and 2024. HRQOL was measured using the validated Celiac Disease Quality of Life (CD-QOL) questionnaire. Descriptive, bivariate, and multivariable regression analyses were performed to explore changes over time and factors associated with better outcomes. We analyzed 2254 surveys (1208 from 2014; 1046 from 2024). Overall HRQOL remained stable across the decade. Longer duration since diagnosis and more years on a GFD were consistently associated with better emotional and functional well-being. Age showed a modest positive association with HRQOL, while women reported poorer scores in health-concerns domains. Despite increased disease awareness and improvements in gluten-free product availability in Spain over the past decade, perceived quality of life has not meaningfully improved. Quality of life in adults with CD in Spain has not changed over ten years, suggesting that dietary management alone might be insufficient to achieve optimal well-being. Early diagnosis and structured long-term follow-up, including psychological support, could help address persistent emotional and social challenges. Strategies that go beyond diet are needed to enhance patient-centred outcomes in CD.