Celiac Disease

CD: Introduction (2009)

Guideline Title

Celiac Disease (2009) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on medical nutrition therapy (MNT) for people with celiac disease. The primary goals of MNT for people with celiac disease are to promote optimal health, to prevent and treat malabsorption/malnutrition and other comorbidities, and improve quality of life.

Guideline Development 

This guideline is intended for use by Registered Dietitians (RDs) involved in providing MNT to people with celiac disease. The guideline must be individualized,  but it will assist the Registered Dietitian in successfully integrating MNT into the overall medical management of people with celiac disease. The recommendations in the guideline were based on a systematic review of the literature. Topics include:
 
  • Long-term effectiveness of a gluten-free dietary pattern on bone density, hematological variables, villous atrophy, pregnancy outcomes, neurological symptoms and gastrointestinal symptoms
  • Inclusion of oats in the dietary pattern
  • Quality of life

The recommendations are based on the work performed by the American Dietetic Association Celiac Disease expert work group. The number of supporting documents for these topics is below:

  • Recommendations: Seventeen (17)
  • Conclusion Statements:  Ten (10)
  • Evidence Summaries:  Ten (10)
  • Article Worksheets:  One hundred and fifty-six (156)
Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.

Revision

The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research, a determination will be made about whether the new information could change the published recommendation or rating.

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see ADA Evidence Analysis Manual).

When the analysis is completed, the expert workgroup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years.

Medical Nutrition Therapy and Celiac Disease

Scientific evidence supports the effectiveness of medical nutrition therapy to increase effectiveness of therapy for celiac disease. Topics included in this guideline are:

  • Medical nutrition therapy and dietitian intervention
  • Gluten-free dietary pattern
  • Inclusion of oats in the dietary pattern
  • Quality of life
  • Education
The Registered Dietitian plays an integral role on the interdisciplinary care team by determining the optimal nutrition prescription and developing the nutrition care plan for patients undergoing therapy for celiac disease. Based on the patient’s treatment plan and comorbid conditions, other nutrition practice guidelines, such as weight management and diabetes care guidelines,  may be needed in order to provide optimal treatment.

 Populations to Whom This Guideline May Apply

This guideline applies to people with celiac disease.

Other Guideline Overview Material

For more details on the guideline components, use the links on the left to access:

  • Scope of Guideline
  • Statement of Intent
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementating the Recommendations.

Contraindications

Clinical judgment is crucial in the application of these guidelines.  Careful consideration should be given to the application of these guidelines for patients with significant medical co-morbidities.