The EAL is seeking RDNs and NDTRs who work with patients, clients, or the public to treat children and adolescents living with type 1 diabetes, for participation in a usability test and focus group. Interested participants should email a professional resume to by July 15, 2024.

CD: Guideline Recommendations and Supporting Evidence (2021)

CD: Guideline Recommendations and Supporting Evidence (2021)

Guideline recommendations are the essence of evidence-based guidelines and provide a course of action  for the practitioner based on the evidence. Below, you will find a list of the Celiac Disease (2021) recommendations organized by Nutrition Care Process category.  

Each recommendation was developed from specific systematic review questions. Please download the Relationship between PICO Questions and Recommendations Table for details. Download the Summary of Changes Table for  an overview of the recommendation revisions and updates from the Celiac Disease 2009 guideline.

The Academy categorizes recommendations in terms of either Imperative or Conditional statements. Conditional statements clearly define a specific situation or specific sub-population with the larger guideline population. Imperative statements are broadly applicable to the target population without restraints on their application. Each recommendation receives a rating, using the scale Strong, Fair, Weak, Consensus, or Insufficient Evidence. The rating for the recommendation is primarily based on the strength of the supporting evidence but also the balance between benefits or harms anticipated and the clinical practice implications when the statement is follows. Learn more →

The Academy is transitioning to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework for developing clinical recommendations. The Celiac Disease (2021) recommendations were developed using both formats and were assigned ratings in both systems. Learn more →

Resources Available with Each Recommendation

In addition to the recommendation statement and strength rating, you will find on each recommendation page:

  • A brief narrative summary of the evidence analyzed to reach the recommendation
  • A statement of justification, or reason for the strength of the recommendation
  • Detailed information on the evidence supporting the recommendations and background narrative (available in the Supporting Evidence section toward the bottom of each recommendation page)
  • A reference list at the end of each recommendation page that includes all the sources used in the evidence analysis for the particular recommendation (each reference is hyperlinked to a summary of the article analyzed in the evidence analysis).

Click on the blue recommendation title to view the full recommendations.

Nutrition Assessment

CD: Routine Nutrition Assessment

Nutrition Intervention

CD: Medical Nutrition Therapy to Improve Outcomes

CD: FODMAP Dietary Pattern

CD: Gluten-Free Diet

  • Gluten-Free Dietary Pattern
  • Gluten-Free Dietary Pattern for Growth and Development

CD: Inclusion of Gluten-Free Oats

  • Adults
  • Children

CD: Addition of Vitamin and Mineral Supplements

CD: Prebiotics or Probiotics Supplementation 


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