Celiac disease (CD) is a chronic autoimmune disorder whose impact extends beyond the gastrointestinal tract, significantly affecting quality of life (QoL). Adherence to a gluten-free diet (GFD)—the cornerstone of treatment—is essential to prevent complications and improve well-being, yet maintaining strict adherence remains challenging. This study aimed to evaluate QoL in adult patients with CD, assess adherence to a GFD, and identify factors influencing both outcomes.

A cross-sectional descriptive and analytical study was conducted over a three-month period (October–December 2023) among 100 adult members of the Tunisian Celiac Disease Association. QoL was assessed using two validated Arabic questionnaires: the generic SF-12 and the disease-specific Celiac Disease Questionnaire (CDQ). Adherence was evaluated using the Biagi Score, classifying patients into good (score 3–4) versus poor adherence (score 0–2). Sociodemographic, clinical, and socioeconomic factors associated with impaired QoL and poor adherence were analyzed using uni- and multivariate regression.

The cohort included 100 patients (mean age 34.5 ± 9.5 years; sex ratio M/F = 0.39). Median age at diagnosis was 11 years and the median disease duration was 21.5 years. Only 27% reported strict adherence to a GFD (Biagi Score 3–4).QoL was globally impaired, with a mean SF-12 score of 26.0 ± 4.0 and a mean CDQ score of 123.9 ± 29.6. In univariate analysis, impaired QoL was associated with female sex (p = 0.02), low educational level (p < 0.001), low socioeconomic status (p = 0.01), and autoimmune comorbidities (p = 0.04). After adjustment, low educational level (β = 0.21; p = 0.03) and low socioeconomic status (β = 0.25; p = 0.04) remained independent predictors of impaired QoL.Good adherence to the GFD was more frequent in older patients (>40 years; p = 0.025) and women (p = 0.04), although no independent predictors were confirmed in multivariate analysis. Reported barriers included gluten-rich dietary habits, high cost of gluten-free products, limited food availability, and low socioeconomic and educational levels.

Celiac disease exerts a substantial impact on quality of life, particularly among patients with low socioeconomic and educational backgrounds. Adherence to a gluten-free diet remains low and is hindered by economic, cultural, and accessibility constraints. These findings underscore the need for a comprehensive care strategy integrating nutritional education, psychological support, and socioeconomic assistance to improve both QoL and long-term therapeutic adherence in patients with CD.