Celiac Disease (CD) Assessment of Food/Nutrition-Related History

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

Recommendation(s)

CD: Assessment of Food/Nutrition-Related History

The registered dietitian (RD) should assess the food and nutrition-related history of individuals with celiac disease, including (but not limited to) the following:

• Food and nutrient intake (e.g., diet history, diet experience and macronutrient or micronutrient intake, specifically calcium, iron, vitamin B complex and vitamin D)
• Medication and herbal supplement use
• Knowledge, beliefs or attitudes (e.g., readiness to change nutrition-related behaviors)
• Behavior (e.g., social network)
• Factors affecting access to food and food and nutrition-related supplies (e.g., safe food and meal availability).

Assessment of the above factors is needed to effectively determine nutrition diagnoses and plan the nutrition intervention. Intake of gluten results may result in gastrointestinal symptoms, malabsorption and villous atrophy.

Rating: Strong
Imperative

Risks/Harms of Implementing This Recommendation

None.

Conditions of Application

None specified.

Potential Costs Associated with Application

Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.

Recommendation Narrative

• Several studies report that individuals who are compliant with a gluten-free dietary pattern have substantial improvement in villous atrophy; however, mucosal abnormalities may persist in some individuals
• Normalization of abnormalities may occur within one year, but generally takes longer, depending on the severity of villous atrophy, level of dietary compliance and age at diagnosis (Dickey et al, 2000; Kaukinen et al, 2002; Lee et al, 2003; Abrams et al, 2004)
• One study indicated that recovery in children may progress faster and more completely than in adults (Wahab et al, 2002)
• Several studies report that improvement in villous atrophy is not dependent on the type of gluten-free dietary pattern; however, villous atrophy is significantly associated with dietary compliance (Janatuinen et al, 1995; Kemppainen et al, 1998; Kaukinen et al, 1999; Selby et al, 1999; Lohiniemi et al, 2000; Janatuinen et al, 2000; Ciacci et al, 2002; Janatuinen et al, 2002; Peraaho et al, 2003; Hogberg et al, 2004; Peraaho et al, 2004; Baudon et al, 2005; Ciacci et al, 2005)
• Further research is needed to determine the factors involved with the persistence of mucosal abnormalities in those adhering to a gluten-free dietary pattern
• Several studies have reported that people with celiac disease are more likely to experience gastrointestinal symptoms such as diarrhea, constipation, abdominal pain and bloating, nausea or vomiting, reduced gut motility, delayed gastric emptying and prolonged transit time than healthy controls (Cucchiara et al, 1995; Usai et al, 1995; Chiarioni et al, 1997; Fine et al, 1997; Benini et al, 2001; Cuomo et al, 2003; Midhagen et al, 2003; Tursi et al, 2003; Murray et al, 2004; Hopper et al, 2005; Viljamaa et al, 2005; Casellas et al, 2006)
• Compliance with a gluten-free diet reduces the prevalence of these symptoms
• Further evaluation of persistent gastrointestinal symptoms in some persons with celiac disease is recommended. Evidence is limited regarding the effect of a gluten-free dietary pattern on indigestion, dysphagia and reflux; additional research is needed in these areas.

Recommendation Strength Rationale

Both conclusion statements received Grade II.

Minority Opinions

Consensus reached.

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Supporting Evidence

The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

What is the long-term effectiveness in people with celiac disease of following a gluten-free dietary pattern on villous atrophy?

What is the long-term effectiveness in people with celiac disease of following a gluten-free dietary pattern on gastrointestinal symptoms?

References

Abrams JA, Diamond B, Rotterdam H, Green PHR. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy. Digestive Diseases and Sciences 2004;49(4):546-550.

Baudon JJ, Chevalier J, Boccon-Gibod L, Le Bars MA, Johanet C, Cosnes J. Outcome of infants with celiac disease. Gastroenterol Clin Biol 2005;29:1097-1102.

Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion 2002; 66(3): 178-185.

Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G. Grown-up celiac children: the effects of only a few years on a gluten-free diet in childhood. Aliment Pharmacol Ther 2005; 21(4): 421-429.

Dickey W, Hughes DF, McMillan SA. Disappearance of endomysial antibodies in treated celiac disease does not indicate histological recovery. Am J Gastroenterol 2000; 95(3): 712-714.

Hogberg L, Laurin P, Falth-Magnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L. Oats to children with newly diagnosed celiac disease: a randomized double blind study. Gut 2004; 53:649-654.

Janatuinen EK, Kemppainen TA, Julkunen RJK, Kosma VM, Maki M, Heikkinen M, Uusitupa MIJ. No harm from five year ingestion of oats in celiac disease. Gut 2002; 50: 332-335.

Janatuinen EK, Kemppainen TA, Pikkarainen PH, Holm KH, Kosma VM, Uusitupa MIJ, Maki M, Julkunen RJK. Lack of cellular and humoral immunological responses to oats in adults with celiac disease. Gut 2000; 46: 327-331.

Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RMK, Uusitupa MIJ, Julkunen RJK. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995; 333: 1033-7.

Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M. Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis. A long-term follow-up study. Scand J Gastroenterol 1999; 34: 163-169.

Kaukinen K, Sulkanen S, Maki M, Collin P. IgA-class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in celiac disease. Eur J Gastroenterol Hepatol 2002; 14(3): 311-315.

Kemppainen TA, Kosma VM, Janatuinen EK, Julkunen RJ, Pikkarainen PH, Uusitupa MI. Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet - association with the grade of mucosal villous atrophy. Am J Clin Nutr 1998; 67(3): 482-487.

Lee SK, Lo W, Memeo L, Rotterdam H, Green PH. Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc 2003; 57(2): 187-191.

Lohiniemi S, Maki M, Kaukinen K, Laippala P, Collin P. Gastrointestinal symptoms rating scale in coeliac disease patients on wheat starch-based gluten-free diets. Scand J Gastroenterol 2000; 35:947-949.

Peraaho M, Kaukinen K, Paasikivi K, Sievanen H, Lohiniemi S, Maki M, Collin P. Wheat-starch-based gluten-free products in the treatment of newly detected coeliac disease: Prospective and randomized study. Aliment Pharmacol Ther 2003; 17:587-594.

Peraaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Maki M, Laippala P, Collin P. Effect of an oats-containing gluten-free diet on symptoms and quality of life in celiac disease. A randomized study. Scand J Gastroenterol 2004; 39:27-31.

Selby WS, Painter D, Collins A, Faulkner-Hogg KB, Loblay RH. Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten. Scand J Gastroenterol 1999; 34: 909-914.

Wahab PJ, Meijer JWR, Mulder CJJ. Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. Am J Clin Pathol 2002; 118(3): 459-463.

Benini L, Sembenini C, Salandini L, Dall'O E, Bonfante F, Vantini I. Gastric emptying of realistic meals with and without gluten in patients with celiac disease. Effect of jejunal mucosal recovery. Scand J Gastroenterol 2001;36(10):1044-1048.

Casellas F, Lopez Vivancos J, Malagelada JR. Current epidemiology and accessibility to diet compliance in adult celiac disease. Rev Esp Enferm Dig 2006;98(6):408-419.

Chiarioni G, Bassotti G, Germani U, Battaglia E, Brentegani MT, Morelli A, Vantini I. Gluten-free diet normalizes mouth-to-cecum transit of a caloric meal in adult patients with celiac disease. Dig Dis Sci 1997;42(10):2100-2105.

Cucchiara S, Bassotti G, Castellucci G, Minella R, Betti C, Fusaro C, Morelli A, Bertotto A, Auricchio S. Upper gastrointestinal motor abnormalities in children with active celiac disease. J Pediatr Gastroenterol Nutr 1995;21(4):435-442.

Cuomo A, Romano M, Rocco A, Budillon G, Del Vecchio Blanco C, Nardone G. Reflux esophagitis in adult celiac disease: beneficial effect of gluten-free diet. Gut 2003;52:514-517.

Fine KD, Meyer RL, Lee EL. The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology 1997;112(6):1830-1838.

Hopper AD, Leeds JS, Hurlstone DP, Hadjivassiliou M, Drew K, Sanders DS. Are lower gastrointestinal investigations necessary in patients with celiac disease? Eur J Gastroenterol Hepatol 2005;17(6):617-21.

Midhagen G, Hallert C. High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study. Am J Gastroenterol 2003;98(9):2023-2026.

Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr 2004; 79: 669-673.

Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol 2003;98(4):839-843.

Usai P, Bassotti G, Usai Satta P, Cherchi MV, Plesa A, Boy F, Morelli A, Balestrieri A. Oesophageal motility in adult celiac disease. Neurogastroenterol Motil 1995;7(4):239-244.

Viljamaa M, Collin P, Huhtala H, Sievanen H, Maki M, Kaukinen K. Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther 2005;22(4):317-24.

References not graded in ADA's Evidence Analysis Process

National Institutes of Health. National Institutes of Health Consensus Development Conference Statement: Celiac Disease. Available at: http://consensus.nih.gov/2004/2004CeliacDisease118html.htm.