CD: Executive Summary of Recommendations (2021)
Executive Summary of Recommendations
Below are the recommendations and ratings for the Academy of Nutrition and Dietetics Celiac Disease (CD) Evidence-Based Nutrition Practice Guideline. Use the links on the left to view the Guideline Introduction. Detailed recommendations, including the evidence supporting these recommendations, is available from the Major Recommendations tab.
Each recommendation was developed from specific systematic review questions. Please download the Relationship between PICO Questions and Recommendations table for details.
For a description of the GRADE Recommendation Rating scheme (Level 1 [1A, 1B, 1C, 1D], Level 2 [2A, 2B, 2C, 2D]), click here.
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Nutrition Assessment
CD: Routine Nutrition Assessment
In individuals newly diagnosed with celiac disease, it is reasonable that a registered dietitian nutritionist or an international equivalent conduct a comprehensive initial nutrition assessment and evaluates individual ability (including but not limited to access to gluten-free food, socioeconomic barriers, label and menu reading, food preparation, and avoidance of cross-contact skills) and willingness to implement a gluten-free diet, the only available treatment for celiac disease. Follow-up assessments should be individualized according to individual response to treatment, changes in ability or willingness to continue treatment, and signs and symptoms related to celiac disease.
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Nutrition Intervention
CD: Medical Nutrition Therapy to Improve Outcomes
In all individuals with celiac disease, it is reasonable for a registered dietitian nutritionist or an international equivalent to collaborate with individuals with celiac disease, their families, and interdisciplinary healthcare teams to design individualized medical nutrition therapy based upon the individual’s overall health and nutritional status, personal preferences, psychological and psychosocial factors, and physiological needs. Medical nutrition therapy for individuals with celiac disease should focus on comprehensive nutrition assessment and appropriate interventions, including individualized modification of diet, to maintain or improve nutrition status, and monitoring over time.
CD: FODMAP Dietary Pattern
In adults with celiac disease and refractory abdominal symptoms, there is insufficient evidence to suggest a low-FODMAP restriction in addition to gluten-free dietary pattern.
CD: Gluten-Free Dietary Pattern
For all individuals with celiac disease, the registered dietitian nutritionist or an international equivalent should recommend following a gluten-free dietary pattern and adherence to this dietary pattern to improve gastrointestinal health and symptoms, quality of life, quality of dietary intake, maintenance or achievement of a normal body mass index or weight, and improvement in celiac disease-related antibodies, inflammatory and immunological indicators.
CD: Gluten-Free Dietary Pattern for Growth and Development
In children with celiac disease, the registered dietitian nutritionist or an international equivalent should recommend a nutritionally adequate gluten-free dietary pattern to achieve and maintain appropriate growth and development.
CD: Inclusion of Gluten-free Oats: Adult
In adults with celiac disease, the registered dietitian nutritionist or an international equivalent may suggest incorporating gluten-free oats as part of a nutritionally adequate gluten-free diet.
CD: Inclusion of Gluten-free Oats: Children
In children with celiac disease, gluten-free oats are an appropriate option as part of a nutritionally adequate gluten-free diet.
CD: Addition of Vitamin and Mineral Supplements
For all individuals with celiac disease, it is reasonable for the registered dietitian nutritionist or international equivalent to advise daily consumption of gluten-free age-and sex-appropriate vitamin and mineral supplements if dietary intake and/or laboratory tests indicate nutritional inadequacies.
CD: Prebiotics or Probiotics Supplementation
In all individuals with celiac disease following a gluten-free diet, there is insufficient evidence at this time to suggest prebiotics or probiotics supplementation.
