Medical Nutrition Therapy

MNT: Gastrointestinal Disorders (2015

• Intervention
  In adults with gastrointestinal disorders (i.e., inflammatory bowel syndrome/disease, Crohn’s disease, ulcerative colitis), what is the cost benefit of MNT provided by a Registered Dietitian Nutritionist (RDN)?

  • Conclusion
    No published research studies were found on this topic. Future research assessing the cost effectiveness of MNT provided by a nutrition professional (registered dietitian nutritionist or equivalent) to improve gastrointestinal disorder outcomes is imperative.
  • Grade: V
    • 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: In adults with gastrointestinal disorders (i.e., inflammatory bowel syndrome or disease, Crohn’s disease, ulcerative colitis), what is the cost benefit and effectiveness of MNT provided by a Registered Dietitian on health outcomes (i.e., weight status, GI distress, nutrient deficiencies)?
    • Detail
  • Search Plan and Results: MNT: MNT by RDN - GI Disorders (2015)
     
  In adults with gastrointestinal disorders (i.e., celiac disease, inflammatory bowel syndrome/disease, Crohn’s disease, ulcerative colitis), what is the effectiveness of MNT provided by a Registered Dietitian Nutritionist (RDN) on health outcomes (i.e., weight status, GI distress, nutrient deficiencies)?

  • Conclusion
    Evidence suggests that patients with celiac disease who received MNT by a nutrition professional (registered dietitian nutritionist or equivalent) had increased adherence to the GF diet, reduced gastrointestinal distress, improved intestinal villous atrophy and improved BMI, although the extent of positive outcomes varied among the studies. Additional research is required. No conclusions could be drawn about the optimal frequency, duration of nutrition professional (RDN or equivalent) visits or MNT effectiveness for other gastrointestinal disorders.
  • Grade: III
    • 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: In adults with gastrointestinal disorders (i.e., celiac disease, inflammatory bowel syndrome or disease, Crohn’s disease, ulcerative colitis), what is the effectiveness of MNT provided by a Registered Dietitian Nutritionist (RDN) on health outcomes (i.e., weight status, GI distress, nutrient deficiencies)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
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      • Cheng J, Brar PS, Lee AR,Green PHR. Body mass index in celiac disease. Beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010; 44(4): 267-271.
      • Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010; 25 (2): 252-258.
      • Hollon JR, Cureton PA, Martin ML, Leonard Puppa EL, Fasano A. Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients. BMC Gastroenterol. 2013; 13 (40): 13-40.
      • Kabbani TA, Goldberg A, Kelly CP, Pallav K, Tariq S, Peer A, Hansen J, Dennis M, Leffler DA. Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment Pharmacol Ther. 2012; 35 (6): 723-729.
      • Lee AR, Ng DL, Dave E, Ciaccio EJ, Green PHR. 2009. The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet. J Hum Nutr Diet, 22, pp. 359-363. doi: 10.1111/j.1365-277X.2009.00970.x
      • Mahadev S, Simpson S, Lebwohl B, Lewis SK, Tennyson CA, Green PHR. Is dietitian use associated with celiac disease outcomes? Nutrients, 2013; 5: 1,585-1,594.
      • Nelson M, Mendoza N, McGough N. A survey of provision of dietetic services for coeliac disease in the UK. J Hum Nutr Diet. 2007; 20: 403-411.
      • Niewinski MM. Advances in celiac disease and gluten-free diet. J Am Diet Assoc. 2008; 108 (4): 661-672.
      • Pulido O, Zarkadas M, Dubois S, MacIsaac K, Cantin I, La Vieille S, Godefroy S, Rashid M. Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease. Can J Gastroenterol. 2013; 27 (8): 449-453.
      •  Simpson S, Thompson T. Nutrition assessment in celiac disease. Gastrointest Endoscopy Clin N Amer. 2012; 22: 797-809.
      • Stuckey C, Lowdon J, Howdle P. Symposium 1: Joint BAPEN and British Society of Gastroenterology Symposium on 'coelic disease: basics and controversies' Dietitians are better than clinicians in following up coelic disease. Proc Nutr Soc. 2009; 68 (3): 234-241.
  • Search Plan and Results: MNT: MNT by RDN - GI Disorders (2015)