Attitudes, Behaviors, and Perceptions Toward Gluten-Free Food Labeling in Gluten-Related Diseases: A Systematic Review and Meta-Analysis

Gluten-related diseases (GRDs), affecting approximately 1–6% of the global population, require long-term adherence to a gluten-free (GF) diet for effective disease management. Food label literacy plays a critical role in ensuring dietary safety; however, consumer attitudes, behaviors, and perceptions regarding GF food labeling remain insufficiently characterized. This study systematically reviewed and synthesized evidence on these factors across different GRDs. A comprehensive search of PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted for studies published between January 2000 and December 2025. Studies evaluating attitudes, beliefs, and behaviors related to GF food labeling among individuals with GRDs were included. A total of 82 studies involving 61,284 participants from 27 countries were included, with 44 studies contributing to the meta-analysis. Consistent GF label reading was reported by 79.2% of participants, while 60.3% expressed confidence in label accuracy. However, 40.9% reported dietary infractions due to misleading labeling. Label reading behavior varied across disease groups and regulatory settings. Key barriers included ambiguous wording, inconsistent cross-contamination disclosures, and lack of standardized symbols. These findings highlight important gaps in labeling practices and emphasize the need for standardized regulations and targeted educational interventions to improve dietary safety and health outcomes.