J Hum Nutr Diet. 2025 Feb;38(1):e13380. doi: 10.1111/jhn.13380. Epub 2024 Nov 5.

Anne R Lee ¹, Melinda Dennis ², Jessica Lebovits ¹, Lori Welstead ³, Ritu Verma ³, Amelie Therrien ², Benjamin Lebwohl ¹

Author information

¹Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Columbia University, New York, New York, USA.

²Division of Gastroenterology, Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

³Divisions of Pediatric and Adult Gastroenterology, Hepatology, and Nutrition, Celiac Disease Center, University of Chicago, Chicago, Illinois, USA.

Abstract

Background: Coeliac disease (CeD) is a type of enteropathy characterised by an immune-mediated reaction to ingested gluten, resulting in impaired absorption of nutrients and symptoms such as bloating, abdominal cramping and diarrhoea. Currently, the only treatment for CeD is adherence to a gluten-free diet (GFD). The latest draft guidance from the US Food and Drug Administration recommends that dietitians experienced in CeD management evaluate patients during the screening and treatment period of CeD clinical trials to assess adherence to a GFD. However, there are currently no standardised guidelines on dietary assessment of patients with CeD on a GFD and there is a lack of widespread availability of expertise in this field.

Methods: Based on the findings of a literature review conducted between April and September 2023, this article provides an overview of key points to consider in the nutritional and dietary assessment of patients with CeD who are following a GFD, with particular focus on the clinical trial setting.

Results: Based on a consensus from dietitians and gastroenterologists experienced in treating patients with CeD, we present specific recommendations for registered dietitians who manage patients with CeD. We also describe the development of a simplified tool for assessment of adherence to a GFD, the Gluten-Free Adherence Survey, based on these recommendations.

Conclusions: These guidelines cover nutritional and dietary assessment of patients with CeD, physical assessments, intake of oats, environmental considerations and the disease burden.