Gluten-Free Diet: Nutritional Strategies to Improve Eating Habits in Children with Celiac Disease: A Prospective, Single-arm Intervention Study

Abstract

Background: Elimination of gluten-containing cereals and consumption of ultra-processed gluten-free foods might cause an unbalanced diet, deficient in fiber and rich in sugar and fat, circumstances that may predispose celiac children to chronic constipation. Aim: to evaluate if counseling with a registered dietitian (RD) was capable of improving eating and bowel habits in a celiac pediatric population. Methods: Dietetic, lipid profile and stool modifications were analyzed, comparing baseline assessments with those twelve months after receiving heathy eating and nutrition education sessions. At both time points, 3-day food records, a bowel habit record and a lipid panel were conducted. Calculated relative intake of macro- and micro-nutrients were compared with current recommendations by the European Food Safety Authority (EFSA). Student’s paired t-test, McNemar test, Mandasky test and Pearson correlation tests were used. Results: Seventy-two subjects (58.3% girls) with a mean (standard deviation (SD)) age of 10.2 (3.4) years were included. Baseline diets were imbalanced in macronutrient composition. Significant improvements were observed in their compliance with dietary reference values (DRVs), where 50% of the subjects met fat requirements after the education and 67% and 49% with those of carbohydrates and fiber, respectively (p < 0.001). Celiac children decreased red meat and ultra-processed foods consumption (p < 0.001) and increased fruits and vegetables intake (p < 0.001), leading to a reduction in saturated fat (p < 0.001) and sugar intake (p < 0.001). Furthermore, 92% of the patients achieved a normal bowel habit, including absence of hard stools in 80% of children constipated at baseline (p < 0.001). Conclusions: RD-led nutrition education is able to improve eating patterns in children with celiac disease (CD).

Adherence to the Mediterranean Diet and Ultra-Processed Foods Consumption in a Group of Italian Patients with Celiac Disease

“…Furthermore, considering the presence of gluten-free products as a source of UPF in the diets of people with CD, it should also be relevant to promote the consumption of naturally gluten-free cereals to improve the diet quality of people with CD. In fact, some studies have already demonstrated the efficacy of nutrition education in people with CD, reporting an improvement in UPF consumption and better adherence to MD in children, adolescents [ 15 , 33 ], and adults [ 26 ].…”

Gluten‐free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease

“…Patients educated by a dietitian are more likely to make healthier food choices 110 . In a recent intervention study on 72 children, there were significant improvements in their dietary habits when educated by a dietitian, with lower intakes of sugar and ultra‐processed foods and overall increase of fruits and fiber 111 Thus, nutrition education of patients and their families by a dietitian may improve nutritional and health status.…”

“…As the GFD is complex and requires several skills in nutrition, food labeling, adaption to family food culture, a clinical dietitian trained in CD is recommended to give both the first as well as the continued education on the GFD. 42,115 The dietitian supports the adherence to the GFD, 116 adherence to healthier dietary habits, 111 is safe and cost effective in the follow-up care, 117 and patients appreciate the contact with the dietitian. 118 Monitoring patients with both type 1 diabetes and CD is particularly challenging.…”

Study Protocol for a Controlled Trial of Nutrition Education Intervention about Celiac Disease in Primary School: ZELIAKIDE Project

“…So far, nutrition education about CD and diet has been focused on people suffering from CD [43][44][45][46][47] as it is necessary to improve their health and quality of life. Nevertheless, nutrition education should go beyond the patient, since family members and social environments also have an influence on the management of the disease, as previous studies have shown [48][49][50][51][52][53][54][55].…”