Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 1 Date: 26 May 2025
Reviewer:  Wajiha Mehtab
Reviewer's report:
BACKGROUND
Para 1, line 2: “some other grains” can be named.
Para 1, line 9: please write in brief or estimate details of “which group” of CeD patients can
face complications.
Rationale is not clear. Looks like developing a questionnaire with too many objectives.
METHODS
How was the questionnaire developed? Since you have mentioned that a pre-designed
questionnaire was used, then please explain the methodology used to design the questionnaire
like review of literature, group discussions, expert meetings, etc. Who was involved in
developing the questionnaire?
Please explain about the questionnaire, number of questions in each section, etc. Was it pilot
tested before application? If yes, please give details.
Para 2 mentions that the questionnaire was applied at two points, while para 1 mentions that it
is a cross-sectional study (one-time). The methodology is not clear.
Also, demographics like the one mentioned in the study, are basic general information which are
recorded in all types of questionnaires and hence need not require to be used as a development
or  validation point.
In para 1, sample size is being repeated. Write in one line that how many were diagnosed and
how many were recruited.
What Is the clinical data which is assessed in the questionnaire? Not clear.
Biagi questionnaire is a very old questionnaire which does not include all aspects of adherence
and cannot be applied to all populations. Other questionnaires on adherence like Celiac disease
adherence test (CDAT), Standard dietary evaluation (SDE) are also available and must have been
incorporated in the study to capture a bigger picture of adherence. With just Biagi questionnaire,
we cannot certain that the true adherence of a patient is captured.
It is also mentioned that subjective questions were asked. Please give details about that.
STATISTICAL ANALYSIS
It is written in very detail which is not required. Also, terms like disease absence, CeD duration
groups, Comorbidity prevalence, etc. are not given in methods. They have been covered under
which section? Please write in methods first to match with statistics.
RESULTS:
Results mention two new terms including “lifestyle factors and Gluten-Free Diet Adherence
Patterns and Behavioral Trends” which were not mentioned in methodology.
It is mentioned in the methodology that study was conducted at two points: “initially at the time
of diagnosis and at recent time duration of study”. It is also given that this is a follow-up study,
which was conducted from Nov 2022 to June 2023. But, the cohorts given are not matching with
time duration mentioned. 24 months follow-up cannot be completed in this time duration. The
methodology needs to be clear. Is it a follow-up study or cross-sectional study? I believe you
have included patients who were already following GFD. If that is the case, this can’t be called
“follow-up” study. Please revise.
How did you enquire about the underlying causes of the lack of good adherence to the diet? Was
a questionnaire used? If yes, give details. Just a blank statement cannot be written.
Was the laboratory values conducted specifically for this study or was they part of their routine
follow-up? If conducted for the study, write in methods about blood collection, tests used, ethics
involved, etc.
Nothing about COVID-19 is mentioned in methods. Where this came from? Was this part of
any questionnaire? If yes, under which section.
Overall study
The rationale mentions about developing a questionnaire, however, the study conducted has
nothing similar to that. Reporting a questionnaire development study is done in a different way,
which follows the steps of development and validation. Your title also doesn’t match either with
the study objectives and results. Need a lot of revision.