Influence of Mediterranean Diet Adherence and Physical Activity on Bone Health in Celiac Children on a Gluten-Free Diet Nestares Pleguezuelo, María Teresa Bonillo Leon, Rocío Maldonado Lozano, José De la Flor Alemany, Marta Aparicio García-Molina, Virginia Celiac disease Gluten-free diet Mediterranean diet Children Body composition We aimed to assess the influence of the Mediterranean Diet adherence and physical activity (PA) on body composition, with a particular focus on bone health, in young patients with celiac disease (CD). The CD group (n = 59) included children with CD with a long (>18 months, n = 41) or recent (<18 months, n = 18) adherence to a gluten-free diet (GFD). The non-celiac group (n = 40) included non-celiac children. After adjusting for potential confounders, the CD group showed lower body weight (p = 0.034), lean mass (p = 0.003), bone mineral content (p = 0.006), and bone Z-score (p = 0.036) than non-celiac children, even when the model was further adjusted for adherence to a GFD for at least 18 months. Among CD children, spending greater time in vigorous physical activity was associated with higher lean mass (p = 0.020) and bone mineral density with evidence of statistical significance (p = 0.078) regardless of the time they followed a GFD. In addition, a greater Mediterranean Diet adherence was associated with a higher bone Z-score (p = 0.020). Moreover, lean mass was strongly associated with bone mineral density and independently explained 12% of its variability (p < 0.001). These findings suggest the importance of correctly monitoring lifestyle in children with CD regarding dietary habits and PA levels to improve lean mass and, consequently, bone quality in this population. 2021-05-14T09:16:33Z 2021-05-14T09:16:33Z 2021 journal article Nestares, T.; Martín-Masot, R.; de Teresa, C.; Bonillo, R.; Maldonado, J.; Flor-Alemany, M.; Aparicio, V.A. Influence of Mediterranean Diet Adherence and Physical Activity on Bone Health in Celiac Children on a Gluten-Free Diet. Nutrients 2021, 13, 1636. https:// doi.org/10.3390/nu13051636 http://hdl.handle.net/10481/68521 10.3390/nu13051636 eng http://creativecommons.org/licenses/by/3.0/es/ open access Atribución 3.0 España MDPI