Nutrition Assessment in Celiac Disease

The gluten-free diet is currently the only treatment for celiac disease, and patients should be monitored closely by a dietitian who is knowledgeable regarding this diet. Evaluation by a dietitian includes a comprehensive assessment of dietary history, with an emphasis on caloric and micronutrient intake. Patient knowledge of the gluten-free diet is assessed and interpretation of food labels is taught. Identification of micronutrient deficiencies or comorbid gastrointestinal conditions may occur during a comprehensive dietary assessment. In patients with evidence of gluten exposure, a thorough evaluation for cross-contamination is performed.

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Nutrition assessment is the first step in the nutrition care process.
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Assessment of typical dietary intake in celiac disease must be thorough.
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The only treatment for celiac disease is a strict, lifelong gluten-free diet.

Key Points

According to the Academy of Nutrition and Dietetics Evidence Analysis Library, “medical nutrition therapy provided by a registered dietitian is strongly recommended for individuals with celiac disease.” Therefore, consultation with a dietitian/nutritionist who has expertise in celiac disease should be mandatory for all patients with celiac disease at diagnosis as well as during follow-up ( Box 1 ). The gluten-free diet is currently the only treatment for celiac disease; patients with celiac disease must be monitored closely by a dietitian to assess the healthfulness of the gluten-free diet as well as to discuss motivation, quality of life, symptom improvement, and barriers to compliance.

Box 1

At diagnosis: initial assessment followed by 2 to 3 more visits within the first year of diagnosis as well as annual visits thereafter (minimally)
Suspicion of gluten ingestion (positive serologies after 1 or more years on a gluten-free diet)
Lactose intolerance
Fructose intolerance
Food allergies
Constipation/diarrhea/gastroesophageal reflux disease
Fluctuations in body mass index: weight gain or loss
Micronutrient deficiencies or toxicities
Gastroparesis
Hypercholesterolemia
Type 1 diabetes
Refractory celiac disease

When to refer patients with celiac disease to a dietitian

Nutrition assessment is the first step in the nutrition care process. During the assessment pertinent data are gathered and compared with normal values. A nutrition diagnosis is determined, and a nutrition care plan developed and prescribed. The nutrition intervention should include goals that are quantifiable, achievable, time defined, and negotiated with the patient so as to improve dietary intake and reduce risk factors. The assessment continues at each patient visit. A complete nutrition assessment includes a review of dietary intake, anthropometric measures, biochemical data, medical tests, and procedures ( Box 2 ). Communication with the referring physician/gastroenterologist is advisable for optimal patient care. During the assessment, the dietitian may determine that a diagnosed patient with gastrointestinal symptoms, not related to gluten intake, could be related to another food-intolerance or medical issue that the physician must investigate. Similarly, the dietitian may determine that a micronutrient deficiency or weight loss is not caused by inadequate caloric intake. Dietitians can also recommend that the physician screen for celiac disease in patients who do not have a diagnosis but exhibit symptoms, significant medical history or family history, or unexplained nutrient deficiencies.

Box 2

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