Celiac Disease

CD: Scope of Guideline (2009)

Below, you will find a list of characteristics that describe the Scope of this Guideline.

Guideline Category

Assessment of Therapeutic Effectiveness, Counseling, Evaluation, Management, Treatment

Clinical Specialty

Allergy and Immunology, Critical Care, Endocrinology, Family Practice, Gastroenterology, Hematology, Neurology, Nutrition, Obstetrics and Gynecology, Pediatrics, Rheumatology

Intended Users

Registered Dietitians, Advanced Practice Nurses, Allied Health Personnel, Nurses, Pharmacists, Physician Assistants, Physicians, Social Workers, Students

Guideline Objective(s)

Overall Objective

To provide MNT guidelines for celiac disease to promote optimal health, prevent and treat malabsorption/malnutrition and other comorbidities, and improve quality of life.

Specific Objectives

To define evidence-based celiac disease nutrition recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
To guide practice decisions that integrate medical, nutritional and behavioral strategies
To achieve consistency in practice among RDs
To provide the RD with data to make recommendations to adjust MNT or recommend other therapies to achieve desired outcomes
To enhance the quality of life for the individual with celiac disease, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
To develop guidelines for interventions that have measurable clinical outcomes
To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Infant (1 to 23 months), Child (6 to 12 years), Adolescent (13 to 18 years), Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

People with celiac disease.

Interventions and Practices Considered

This guideline is based on ADA’s Nutrition Care Process and Model, which involves the following steps:

Nutrition Assessment
Nutrition Diagnosis
Nutrition Intervention
Nutrition Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.

I. Referral to a Registered Dietitian
II. Medical Nutrition Therapy

A. Nutrition Assessment

Below you will find the nutrition assessment terms related to celiac disease care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

1. Client history

Medical/health history
Medication and supplement history
Social history
Personal history

2. Biochemical data—relevant laboratory values

3. Anthropometric measurements

Height, weight and BMI
Weight change rate

4. Food/nutrition history

Food intake
Nutrition and health awareness
Physical activity and exercise
Food availability
Psychosocial and economic issues impacting nutrition therapy
Consideration of co-morbid conditions and need for additional modifications in nutrition care plan

5. Physical examination findings

B. Nutrition Diagnosis

Below you will find the nutrition diagnoses related to celiac disease care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

Inadequate energy intake
Excessive energy intake
Inadequate oral food/beverage intake
Excessive oral food/beverage intake
Inadequate intake from enteral/Parenteral nutrition
Excessive intake from enteral/Parenteral nutrition
Inappropriate infusion of enteral/Parenteral nutrition
Inadequate fluid intake
Excessive fluid intake
Excessive alcohol intake
Evident protein-energy malnutrition
Inadequate fiber intake
Excessive fiber intake
Altered GI function
Altered nutrition-related laboratory values
Underweight
Involuntary weight loss
Overweight/obesity
Involuntary weight gain
Food and nutrition-related knowledge deficit
Swallowing difficulty
Biting/Chewing (Masticatory) difficulty
Physical inactivity
Inability or lack of desire to manage self-care
Impaired ability to prepare foods/meals
Self-feeding difficulty
Limited access to food

C. Nutrition Intervention (Planning and Implementation)

Individualized prescription based on:

1.      Food/Nutrition Intervention

2.      Physical activity Interventions

3.      Behavioral Interventions

4.      Pharmacotherapy, when indicated

Below you will find the nutrition interventions related to celiac disease care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

Meals and snacks

Enteral or Parenteral nutrition
Medical Food Supplements
Bioactive Substance Supplements
Feeding Assistance
Feeding Environment
Comprehensive nutrition education
Nutrition counseling
Strategies
Coordination of nutrition care
Discharge planning and transfer of nutrition care to new setting or provider

D. Monitoring and Evaluation

The monitoring or progress, measuring of outcomes, and evaluating of outcomes against criteria to determine changes in specific indicators of MNT outcomes.

Below you will find the nutrition monitoring and evaluation terms related to celiac disease care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition.

Nutrition-related ADLs and IADLs
Physical activity
Food and nutrient intake outcomes
Nutrition-related physical sign/symptoms outcomes
Nutrition-related patient/client centered outcomes

For more information on the guideline components, use the links on the left to access:

Scope of Guideline
Statement of Intent
Guideline Methods
Implementation of the Guideline
Benefits and Harms of Implementing the Recommendations.