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Recommendations Summary

CD: Meeting Nutritional Needs 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    CD: Consumption of Whole/Enriched Gluten-Free Grains and Products

    The registered dietitian (RD) should advise individuals with celiac disease to consume whole or enriched gluten-free grains and products such as brown rice, wild rice, buckwheat, quinoa, amaranth, millet, sorghum, teff, etc. Research reports that adherence to the gluten-free dietary pattern may result in a diet that is low in carbohydrates, iron, folate, niacin, zinc and fiber.

    Rating: Strong
    Imperative

    CD: Addition of Multivitamin and Mineral Supplement

    If usual food intake shows nutritional inadequacies that cannot be alleviated through improved eating habits, the RD should advise individuals with celiac disease to consume a daily gluten-free age- and sex-specific multivitamin and mineral supplement. Research reports that adherence to the gluten-free dietary pattern may result in a diet that is low in iron, folate, niacin, vitamin B12, calcium, phosphorus and zinc.

    Rating: Strong
    Conditional

    • Risks/Harms of Implementing This Recommendation

      • Regarding the Consumption of Whole/Enriched Gluten-Free Grains and Products recommendation,  individuals who are newly diagnosed or unaccustomed to a higher fiber diet may need to introduce gluten-free whole grains and products gradually into their gluten-free dietary pattern
      • The Consumption of Whole/Enriched Gluten-Free Grains and Products recommendation may be contraindicated in individuals who are on a fiber-restricted diet
      • Regarding the Addition of Multivitamin and Mineral Supplement recommendation, consumption of nutrients exceeding the upper limit of the Dietary Reference Intakes (DRIs) may lead to adverse conditions.

       

    • Conditions of Application

      • Regarding the Consumption of Whole/Enriched Gluten-Free Grains and Products recommendation, refer to the recommendation on Education on Food Cross-Contamination available at ada.portalxm.com/eal/template.cfm
      • The Addition of Multivitamin and Mineral Supplement recommendation applies to individuals when usual food intake shows nutritional inadequacies that cannot be alleviated through improved eating habits
      • Regarding the Addition of Multivitamin and Mineral Supplement recommendation, refer to the recommendation on Provide Resources and Education on Label Reading available at ada.portalxm.com/eal/template.cfm.

    • Potential Costs Associated with Application

      • Specially manufactured whole and enriched gluten-free grains and products may be costly
      • Although costs of medical nutrition therapy (MNT) sessions and reimbursements vary, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • For newly diagnosed children and adults with celiac disease, studies report that compliance with a gluten-free dietary pattern results in significant improvements in nutritional laboratory values such as serum hemoglobin, iron,  zinc and calcium as a result of intestinal healing and improved absorption (Rea et al, 1996; Smecuol et al, 1997; Kemppainen et al, 1998; De Lorenzo et al, 1999; Bardella et al, 2000; Dahele and Ghosh, 2001; Hallert et al, 2002; Dickey and Kearney, 2006)
      • However,  adherence to the gluten-free dietary pattern may result in a diet that is high in fat and low in carbohydrates and fiber, as well as low in iron, folate, niacin, vitamin B12, calcium, phosphorus and zinc (Capristo et al, 1997; Smecuol et al, 1997; Mariani et al, 1998; Bardella et al, 2000; Grehn et al, 2001; Hallert et al, 2002; Thompson et al, 2005; Hopman et al, 2006).

    • Recommendation Strength Rationale

      Conclusion statement was given Grade II.

    • Minority Opinions

      Consensus reached.