Celiac Disease

CD: Nutritional Adequacy (2007)

• Intervention
  Is there nutritional adequacy of a gluten-free dietary pattern in those newly diagnosed with celiac disease?

  • Conclusion

    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.   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 B-12, calcium, phosphorus and zinc.  A small number of studies in adults show a trend toward weight gain after diagnosis; further research is needed in this area.  

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support the nutritional adequacy of a gluten-free dietary pattern?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bardella MT, Fredella C, Prampolini L, Molteni N, Giunta AM, Bianchi PA. Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. Am J Clin Nutr. 2000; 72: 937-939.
      • Capristo E, Mingrone G, Addolorato G, Greco AV, Corazza GR, Gasbarrini G.  Differences in metabolic variables between adult celiac patients at diagnosis and patients on a gluten-free diet.  Scand J Gastronenterol 1997;32(12):1222-9.
      • Dahele A, Ghosh S.  Vitamin B12 deficiency in untreated celiac disease.  Am J Gastroenterol 2001;96(3):745-750.
      • De Lorenzo A, Di Campli C, Andreoli A, Sasso GF, Bonamico M, Gasbarrini A.  Assessment of body composition by bioelectrical impedance in adolescent patients with celiac disease.  Am J Gastroenterol 1999 Oct; 94(10): 2951-2955. 
      • Dickey W, Kearney N.  Overweight in celiac disease:  prevalence, clinical characteristics, and effect of a gluten-free diet.  Am J Gastroenterology 2006;101:2356-2359.
      • Grehn S, Fridell K, Lilliecreutz M, Hallert C.  Dietary habits of Swedish adult celiac patients treated by a gluten-free diet for 10 years.  Scand J Nutrition 2001;45:178-182.
      • Hallert C, Grant C, Grehn S, Granno C, Hulten S, Midhagen G, Strom M, Svensson H, Valdimarsson T.  Evidence of poor vitamin status in celiac patients on a gluten-free diet for 10 years.  Aliment Pharmacol Ther 2002;16:1333-1339.
      • Hopman EGD, le Cessie S, von Blomberg BME, Mearin ML.  Nutritional management of the gluten-free diet in young people with celiac disease in the Netherlands.  J Pediatr Gastroenterol Nutr 2006;43:102-108.
      • 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.
      • Mariani P, Viti MG, Montuori M, La Vecchia A, Cipolletta E, Calvani L, Bonamico M.  The gluten-free diet:  a nutritional risk factor for adolescents with celiac disease?  J Pediatr Gastroenterol Nutr 1998;27:519-523.   
      • 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.
      • Smecuol E, Gonzalez D, Mautalen C, Siccardi A, Cataldi M, Niveloni S, Mazure R, Vazquez H, Pedreira S, Soifer G, Boerr LA, Maurino E, Bai JC.  Longitudinal study on the effect of treatment on body composition and anthropometry of celiac disease patients.  Am J Gastroenterol 1997;92(4):639-43.
      • Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK.  Gluten-free diet survey:  are Americans with celiac disease consuming recommended amounts of fibre, iron, calcium, and grain foods?  J Hum Nutr Diet 2005;18(3):163-9.
  • Search Plan and Results: CD: Nutritional Adequacy of GFD 2007