Background:
Celiac disease (CD) affects approximately 1% of the global population, and lifelong adherence to a gluten-free diet (GFD) remains its only effective treatment. Although GFD promotes intestinal healing, its nutritional imbalance may contribute to excessive weight gain, insulin resistance, dyslipidaemia, metabolic dysfunction-associated steatotic liver disease (MASLD), and increased cardiovascular risk. These metabolic consequences highlight the need for personalized nutritional strategies beyond gluten avoidance.

Methods:

The ARCTIC trial is a prospective, randomized controlled study evaluating the impact of an individualized Mediterranean diet-based dietary education program in adults with CD. Following standardized baseline dietary counselling, participants are randomized (1:1) to either a structured, one-year personalized nutritional intervention or standard dietary care. Individual cardiovascular risk profiles are assessed using comprehensive body composition analysis, metabolic biomarker assessment, liver steatosis evaluation, and detailed dietary assessment. Participants in the intervention arm receive structured dietary education that promotes the principles of the Mediterranean diet within a gluten-free diet. A total of 190 participants (95 per group) are planned to be enrolled to provide 90% statistical power to detect a clinically relevant difference in the primary body composition endpoint (body fat percentage).

Expected Results:

This study introduces a personalized medicine approach to long-term management of CD by integrating individualized nutritional counselling with detailed metabolic assessment. We hypothesize that personalized Mediterranean diet-based education will improve the quality of the gluten-free diet, reduce cardiometabolic risk factors, and support healthier body composition compared with standard care.

Conclusions:

The ARCTIC trial may provide evidence for incorporating precision nutrition into routine follow-up of patients with CD, extending disease management beyond mucosal healing toward personalized prevention of long-term metabolic complications.