Knowledge, perception, and challenges of adopting a gluten-free diet in the Republic of Moldova: A cross-sectional study

Abstract

Gluten-related disorders (GRD), including celiac disease, are managed through a strict gluten-free diet (GFD), the only established treatment. However, widespread awareness and understanding of GFD remains limited, particularly in countries like the Republic of Moldova, where celiac disease prevalence is under-researched. The primary objective of this study is to assess the knowledge, perceptions, and challenges associated with the adoption of a gluten-free diet (GFD) among the Moldovan population. A stratified sampling method was employed to collect 778 responses via an online questionnaire distributed across social media and educational platforms. The questionnaire assessed respondents’ knowledge of gluten and GFD, perceptions of wheat and gluten, and purchasing behavior regarding GF products. Data were analyzed using descriptive statistics and ANOVA to explore differences across education levels and professional domains. Of the respondents, 77.3% could correctly define gluten, yet only 16.1% achieved a knowledge score above 50% regarding gluten-containing products and hidden gluten sources. Education level significantly influenced GFD knowledge (p < 0.05), with respondents holding postgraduate degrees demonstrating higher knowledge scores. Perceptions of gluten and wheat were predominantly neutral among GFD followers and non-followers. However, 21.1% of GFD followers perceived maintaining the diet as highly difficult, primarily due to limited availability and high costs of GF products.The study revealed a significant gap in knowledge of gluten and GFD in the Moldovan population, despite general awareness. Education level and profession were critical determinants of understanding. There is a clear need for targeted educational programs and improved access to GF products to enhance GFD adherence and management of GRD in Moldova. Public health interventions must prioritize raising awareness and addressing the economic barriers associated with GFD.