Celiac Disease

Celiac Disease

Welcome to the Celiac Disease Guideline and Systematic Review

Celiac disease is a genetically-based autoimmune disease characterized by chronic inflammation of the small intestinal mucosa. Individuals with celiac disease have an immunologic reaction to specific sequences of amino acids found in the grains wheat, rye, and barley.

Evidence-Based Nutrition Practice Guideline 

The 2021 guideline is intended for the RDN working with individuals with celiac disease and their families in the United States. The focus of the guideline is on nutritional management for patients with celiac disease and comprehensively covers the following topics:

  • Routine Nutrition Assessment
  • Medical Nutrition Therapy to Improve Outcomes
  • FODMAP Dietary Pattern
  • Gluten-Free Diet
  • Inclusion of Gluten-Free Oats
  • Addition of Vitamin and Mineral Supplements
  • Prebiotics or Probiotics Supplementation

Systematic Review

The primary objective of the Celiac Disease systematic review was to identify, characterize and analyze studies examining the effects of different nutrition interventions. The following sub-topic areas were identified: 

  • FODMAP Diet
  • Gluten-free Diet
  • Oats
  • Supplements
  • Prebiotics and Probiotics
  • Medical Nutrition Therapy

Key results of the systematic review include:

  • There was a greater reduction in self-reported abdominal pain among participants who received a low-FODMAP gluten-free diet in comparison to participants who received a standard gluten-free diet.
  • A gluten-free diet may have a positive effect on dietary intake quality, but this effect varies with levels of adherence to the gluten-free diet.
  • Gluten-free diet and greater adherence to a gluten-free diet may improve the quality of life based on limited evidence.
  • Greater adherence to a gluten-free diet may improve bone mineral density among children with celiac disease.
  • Limited evidence suggests that medical nutrition therapy provided by a registered dietitian nutritionist may help improve quality of life, improve indicators of gastrointestinal health, and improve adherence to a gluten-free diet.
  • Intake of gluten-free oats as a component of the gluten-free diet resulted in a significant increase in dietary fiber and reduction in overall gluten intake.
  • There is limited and inconsistent evidence on the role prebiotics/probiotics play in improving gastrointestinal symptoms.

Use the left navigation bar to view the guideline and systematic review. Expand the section below titled Guideline and Systematic Review Project Team and Disclosures for a listing of individuals who contributed to the development of the project, conflict of interest disclosures, and project funding information.

1/12/2022

  • Resources and Articles

    The following manuscripts and resources from this project have been developed:

  • Scoping Review Project Team and Disclosures (2019)

    The following individuals contributed their valuable time and expertise to the review:

    Project Manager

    • Feon Cheng, PhD, MPH, RDN
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Methodologist

    • Deepa Handu, PhD, RDN
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Content Advisors

    • Anne Roland Lee, PhD, EdD, RDN, LD
      Instructor in Nutritional Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA
    • Mary K. Sharrett, MS, RDN, LD, CNSC
      Nutrition Support Dietitian, Nationwide Children’s Hospital, Columbus, OH, USA

    Financial Contributors

    • Medical Nutrition Practice Group DPG
    • Academy of Nutrition and Dietetics Foundation
    • Academy of Nutrition and Dietetics

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members and content advisors have with companies that sell products or services that are relevant to this topic. Workgroup members and content advisors are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest form. It should not be assumed that these financial interests will have adverse impact on the content, but they are noted here to fully inform readers:

    • None of the content advisors listed above disclosed potential conflicts.
  • Guideline and Systematic Review Project Team and Disclosures (2019-21)

    The following individuals contributed their valuable time and expertise to this project:

    Expert Panel Workgroup Members 

    • M. Angie Almond, MEd, RD, LDN, FAND, Chair
      GLADD Program Coordinator, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
    • Emily M. Germer, MBA, MPH, RDN, LDN
      Dietitian, Matthew Walker Comprehensive Health Center, Nashville, TN, USA
    • Joann M. McDermid, PhD, BSc, MSc, RDN, FAND
      Assistant Professor, University of Virginia, Charlottesville, VA, USA
    • Kristen M. Roberts, PhD, RDN, LD, CNSC, FASPEN, FAND
      Assistant Professor, Ohio State University, Columbus, OH, USA
    • Theresa A. Taylor, MS, RD, LD (joined 9/9/2019)
      Clinical Dietitian, Dayton Childrens's Hospital, Dayton, OH, USA
    • Trish B. Lyons, RDN, LD (resigned 9/1/2019)
    • Marilyn G. Geller, Patient Advocate
      CEO, Celiac Disease Foundation, Los Angeles, CA, USA

    Project Leaders

    • Rachel C. Sinley, PhD, MPH, RD, Project Leader and Lead Analyst
      Department Chair and Associate Professor, Metropolitan State University of Denver, Denver, CO, USA
    • Deepa Handu, PhD, RDN, Project Leader and Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Feon Cheng, PhD, MPH, RDN, CHTS-SP, Project Manager (2018-2020)
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL USA
    • Margaret J. Foster, MS, MPH, AHIP, Medical Librarian
      Texas A&M University, TAMU-Libraries, College Station, TX, USA

    Evidence Analysts

    • Sharon P. Foley, PhD, RDN
      Assistant Professor, Rush University, Chicago, IL, USA
    • Erika Carrasquilla, MS, RD, LDN
      Analyst, Huron Consulting Group, Chicago, IL, USA
    • Lisa A. Davis, MS, RD
      Retired, Middleton, WI, USA
    • Jessica Soldavini, MPH, RD, LDN
      Graduate Research Assistant, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Guideline Reviewers

    • Victoria M.E. Christiansen, RD, LDN, CNSC
      Dietitian, Medical Specialty Clinics: GI and Multiple Sclerosis Clinics Red Deer Regional Hospital, Red Deer, Alberta, Canada
    • Benjamin Lebwohl, MD, MS 
      Associate Professor of Medicine and Epidemiology, Columbia University, New York, NY, USA
    • Marcia Nahikian-Nels, PhD, RD, LD, FAND 
      Professor, Clinical and Director, Academic Affairs School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
    • Lema Safadi, MS, RD 
      Gastrointestinal Medical Scribe, TriHealth, Cincinnati, OH, USA
    • Courtney A. Schuchmann, MS, RD, LDN 
    • Registered Dietitian II, University of Chicago Medicine, Chicago, IL, USA
    • Tayler Silfverduk, RDN 
      Celiac Nutrition Consultant, Columbus, OH, USA
    • Nicole S. Spain, MS, RDN 
      Dietitian, Learning Care Group, Grosse Pointe Farms, MI, USA
    • Nicole Strealy, RDN, LD 
      Owner, Strategic Nutrition, LLC, Lake Oswego, OR, USA
    • Emily L. Van Walleghen, PhD, RD, LD, FAND 
    • Assistant Professor, University of Cincinnati, Cincinnati, OH, USA
    • Chunyun Xiao, MCN, RDN, LD, CNSC, CMI
      Dietitian, Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA

    Financial Contributors

    • Systematic Review
      • Academy of Nutrition and Dietetics
      • Medical Nutrition Practice Group DPG
      • Academy of Nutrition and Dietetics Foundation
    • Evidence-Based Guideline
      • Academy of Nutrition and Dietetics

    The views or interests of the funding bodies did not influence the development of the systematic review or guideline.
     

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers:

    • McDermid J: BIll and Melinda Gates Foundation Grant OPP1141342. Spouse received NSA and FSF grant funding.
    • Geller M: consultant for ICON, Schar, and Takeda; received meeting expenses from Char, Prevention, Bio

     

    8/5/2021