MNT: Gastrointestinal Disorders (2015


Niewinski MM. Advances in celiac disease and gluten-free diet. J Am Diet Assoc. 2008; 108 (4): 661-672.

PubMed ID: 18375224
Study Design:
Narrative Review
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:
To provide clinicians with updated information about celiac disease and its:
  • Diverse clinical presentation
  • Prevalence
  • Complex pathophysiology
  • Genetic predisposition
  • Diagnosis.
Inclusion Criteria:
Not applicable.
Exclusion Criteria:
Not applicable.
Description of Study Protocol:

No specific study methods described for this narrative review.

Data Collection Summary:

The authors only provided professional and consensus opinions on medical nutrition therapy for celiac disease treatment. No specific methods were described as to how the literature was reviewed or synthesized for this article.

Dependent Variables

  • Clinical presentation
  • Prevalence
  • Genetic disposition
  • Pathogenesis
  • Diagnosis
  • Treatment (GF diet, label reading) and future therapeutic options.
Description of Actual Data Sample:

No specific sample data was collected. The authors provided information regarding the medical nutrition therapy for the treatment of the general celiac disease population.

Summary of Results:

Key Findings

  • The authors described the clinical presentation, prevalence, genetic predisposition, pathogenesis and diagnosis of celiac disease
  • They reviewed results of studies that demonstrated positive outcomes with a gluten-free diet as treatment
  • Citations were made with respect to the effects of a gluten-free diet reversing body mass and bone mineral density abnormalities
  • The role of the dietitian specializing in CD was reported and it was stated that several visits with a dietitian were necessary to assess knowledge, competence and compliance, as well as to provide reinforcement
  • There were many resources (online and books) provided and a discussion of label-reading with reference to federal regulations.
Author Conclusion:
  • Celiac disease affects individuals of all ages and is a multi-systemic disorder
  • The gluten-free diet is the only treatment to date but it is complex and challenging to follow
  • Dietitians who specialize in celiac disease provide nutrition assessment, treatment of nutritional deficiencies and education
  • Dietitians provide the tools for better patient understanding of the diet and successful integration of the diet into their lifestyle. This helps lead to improvements in both the physical and emotional consequences of the disease.
Funding Source:
Reviewer Comments:
  • Good review article chronicling CD aspects
  • Narrative review
  • No discussion on study selection, abstraction or synthesis procedures.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? N/A
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? No
Validity Questions
  1. Was the question for the review clearly focused and appropriate? No
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? No
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? No