CD: Assess Biochemical Data and Results of Medical Procedures 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.
CD: Assess Biochemical Data and Results of Medical Procedures
The registered dietitian (RD) should assess the biochemical data and review the results of medical procedures in individuals with celiac disease, regardless of presentation and clinical symptoms, including (but not limited to) the following:
- Gastrointestinal profile [e.g., intestinal biopsy (or skin biopsy in the case of dermatitis herpetiformis) and celiac antibodies]
- Nutritional anemia profile (e.g., folate, ferritin and vitamin B12)
- Vitamin profile (e.g., thiamin, vitamin B6 and 25-hydroxy vitamin D)
- Mineral profile (e.g., copper and zinc)
- Lipid profile
- Electrolyte and renal profile.
Untreated celiac disease results in villous atrophy and malabsorption. The use of effective techniques to assess nutritional status is essential to prevention and treatment of malnutrition and the presence of iron deficiency anemia.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Potential Costs Associated with Application
- Cost of equipment, supplies and staff needs to be addressed in the assessment of biochemical data and medical procedures
- Insurance coverage may vary
- Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.
- For most children and adults with celiac disease, studies report that compliance with a gluten-free dietary pattern results in significant improvements in hematological parameters including serum hemoglobin, iron, ferritin, mean corpuscular volume, mean corpuscular hemoglobin and red cell distribution width (Rea et al, 1996; Annibale et al, 2001; Mitchell and Robinson, 2002; Kapur et al, 2003; Patwari et al, 2003; O'Leary et al, 2004; Rashid et al, 2005; Masjedizadeh et al, 2006; Poddar et al, 2006)
- Recovery of anemia (normalization of hemoglobin concentrations) generally occurs within six months, while recovery from iron deficiency (normalization of ferritin concentrations) may take longer than one year
- 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 (wheat starch-based or naturally gluten-free); 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.
Recommendation Strength Rationale
Both conclusion statements received Grade II.
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the long-term effectiveness in people with celiac disease of following a gluten-free dietary pattern on hematological variables related to iron deficiency anemia?
What is the long-term effectiveness in people with celiac disease of following a gluten-free dietary pattern on villous atrophy?
Annibale B, Severi C, Chistolini A, Antonelli G, Lahner E, Marcheggiano A, Iannoni C, Monarca B, Delle Fave G. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol 2001; 96: 132-137.
Kapur G, Patwari AK, Narayan S, Anand VK. Iron supplementation in children with celiac disease. Indian J Pediatr 2003; 70(12): 955-958.
Masjedizadeh R, Hajiani E, Hashemi J, Shayesteh AA, Moula K, Rajabi T. Celiac disease in South-West of Iran. World J Gastroenterol 2006;12(27):4416-9.
Mitchell RMS and Robinson TJ. Monitoring dietary compliance in coeliac disease using red cell distribution width. Int J Clin Pract 2002; 56(4): 249-250.
O'Leary C, Wieneke P, Healy M, Cronin C, O'Regan P, Shanahan F. Celiac disease and the transition from childhood to adulthood: a 28-year follow up. Am J Gastroenterol 2004; 99:2437-2441.
Patwari AK, Anand VK, Kapur G, Narayan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr 2003 Apr; 40(4): 337-342.
Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the west? J Pediatr Gastroenterol Nutr 2006;43(3):313-7.
Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD. Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 2005;116(6):e754-9.
Rea F, Polito C, Marotta A, Di Toro A, Iovene A, Collini R, Rea L, Sessa G. Restoration of body composition in celiac children after one year of gluten-free diet. J of Pediatric Gastroenterology and Nutrition 1996; 23: 408-412.
Abrams JA, Diamond B, Rotterdam H, Green PHR. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy. Digestive Diseases and Sciences 2004;49(4):546-550.
Baudon JJ, Chevalier J, Boccon-Gibod L, Le Bars MA, Johanet C, Cosnes J. Outcome of infants with celiac disease. Gastroenterol Clin Biol 2005;29:1097-1102.
Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion 2002; 66(3): 178-185.
Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G. Grown-up celiac children: the effects of only a few years on a gluten-free diet in childhood. Aliment Pharmacol Ther 2005; 21(4): 421-429.
Dickey W, Hughes DF, McMillan SA. Disappearance of endomysial antibodies in treated celiac disease does not indicate histological recovery. Am J Gastroenterol 2000; 95(3): 712-714.
Hogberg L, Laurin P, Falth-Magnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L. Oats to children with newly diagnosed celiac disease: a randomized double blind study. Gut 2004; 53:649-654.
Janatuinen EK, Kemppainen TA, Julkunen RJK, Kosma VM, Maki M, Heikkinen M, Uusitupa MIJ. No harm from five year ingestion of oats in celiac disease. Gut 2002; 50: 332-335.
Janatuinen EK, Kemppainen TA, Pikkarainen PH, Holm KH, Kosma VM, Uusitupa MIJ, Maki M, Julkunen RJK. Lack of cellular and humoral immunological responses to oats in adults with celiac disease. Gut 2000; 46: 327-331.
Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RMK, Uusitupa MIJ, Julkunen RJK. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995; 333: 1033-7.
Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M. Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis. A long-term follow-up study. Scand J Gastroenterol 1999; 34: 163-169.
Kaukinen K, Sulkanen S, Maki M, Collin P. IgA-class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in celiac disease. Eur J Gastroenterol Hepatol 2002; 14(3): 311-315.
Kemppainen TA, Kosma VM, Janatuinen EK, Julkunen RJ, Pikkarainen PH, Uusitupa MI. Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet - association with the grade of mucosal villous atrophy. Am J Clin Nutr 1998; 67(3): 482-487.
Lee SK, Lo W, Memeo L, Rotterdam H, Green PH. Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc 2003; 57(2): 187-191.
Lohiniemi S, Maki M, Kaukinen K, Laippala P, Collin P. Gastrointestinal symptoms rating scale in coeliac disease patients on wheat starch-based gluten-free diets. Scand J Gastroenterol 2000; 35:947-949.
Peraaho M, Kaukinen K, Paasikivi K, Sievanen H, Lohiniemi S, Maki M, Collin P. Wheat-starch-based gluten-free products in the treatment of newly detected coeliac disease: Prospective and randomized study. Aliment Pharmacol Ther 2003; 17:587-594.
Peraaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Maki M, Laippala P, Collin P. Effect of an oats-containing gluten-free diet on symptoms and quality of life in celiac disease. A randomized study. Scand J Gastroenterol 2004; 39:27-31.
Selby WS, Painter D, Collins A, Faulkner-Hogg KB, Loblay RH. Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten. Scand J Gastroenterol 1999; 34: 909-914.
Wahab PJ, Meijer JWR, Mulder CJJ. Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. Am J Clin Pathol 2002; 118(3): 459-463.