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Recommendations Summary

CD: Assessment of Food/Nutrition-Related History 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: Assessment of Food/Nutrition-Related History

    The registered dietitian (RD) should assess the food and nutrition-related history of individuals with celiac disease, including (but not limited to) the following: 

    • Food and nutrient intake (e.g., diet history, diet experience and macronutrient or micronutrient intake, specifically calcium, iron, vitamin B complex and vitamin D)
    • Medication and herbal supplement use 
    • Knowledge, beliefs or attitudes (e.g., readiness to change nutrition-related behaviors)
    • Behavior (e.g., social network) 
    • Factors affecting access to food and food and nutrition-related supplies (e.g., safe food and meal availability).

    Assessment of the above factors is needed to effectively determine nutrition diagnoses and plan the nutrition intervention. Intake of gluten results may result in gastrointestinal symptoms,  malabsorption and villous atrophy.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None specified.

    • Potential Costs Associated with Application

      Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • Several studies report that individuals who are compliant with a gluten-free dietary pattern have substantial improvement in villous atrophy; however, mucosal abnormalities may persist in some individuals
      • Normalization of abnormalities may occur within one year, but generally takes longer, depending on the severity of villous atrophy, level of dietary compliance and age at diagnosis (Dickey et al, 2000; Kaukinen et al, 2002; Lee et al, 2003; Abrams et al, 2004)
      • One study indicated that recovery in children may progress faster and more completely than in adults (Wahab et al, 2002)
      • Several studies report that improvement in villous atrophy is not dependent on the type of gluten-free dietary pattern; however, villous atrophy is significantly associated with dietary compliance (Janatuinen et al, 1995; Kemppainen et al, 1998; Kaukinen et al, 1999; Selby et al, 1999; Lohiniemi et al, 2000; Janatuinen et al, 2000; Ciacci et al, 2002; Janatuinen et al, 2002; Peraaho et al, 2003; Hogberg et al, 2004; Peraaho et al, 2004; Baudon et al, 2005; Ciacci et al, 2005)
      • Further research is needed to determine the factors involved with the persistence of mucosal abnormalities in those adhering to a gluten-free dietary pattern
      • Several studies have reported that people with celiac disease are more likely to experience gastrointestinal symptoms such as diarrhea, constipation, abdominal pain and bloating, nausea or vomiting, reduced gut motility, delayed gastric emptying and prolonged transit time than healthy controls (Cucchiara et al, 1995; Usai et al, 1995; Chiarioni et al, 1997; Fine et al, 1997; Benini et al, 2001; Cuomo et al, 2003; Midhagen et al, 2003; Tursi et al, 2003; Murray et al, 2004; Hopper et al, 2005; Viljamaa et al, 2005; Casellas et al, 2006)
      • Compliance with a gluten-free diet reduces the prevalence of these symptoms
      • Further evaluation of persistent gastrointestinal symptoms in some persons with celiac disease is recommended. Evidence is limited regarding the effect of a gluten-free dietary pattern on indigestion, dysphagia and reflux; additional research is needed in these areas.

    • Recommendation Strength Rationale

      Both conclusion statements received Grade II.

    • Minority Opinions

      Consensus reached.