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Recommendations Summary

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.


  • Recommendation(s)

    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.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None specified.

    • 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.

    • Recommendation Narrative

      • 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.

    • Minority Opinions

      Consensus reached.