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Review
. 2023 Sep 16;15(18):4013.
doi: 10.3390/nu15184013.

The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

Edurne Simón  1 , Marta Molero-Luis  2 , Ricardo Fueyo-Díaz  3 , Cristian Costas-Batlle  4 , Paula Crespo-Escobar  5   6 , Miguel A Montoro-Huguet  7   8   9
Affiliations
Review

The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

Edurne Simón et al. Nutrients. .

Abstract

The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.

Keywords: celiac disease; dietitian; gluten immunogenic peptides; health costs; health resources; malnutrition; non-responsive celiac disease; nutrient metabolism gluten-free diet; nutritional assessment; nutritional deficiencies; psychologist.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Remarks for clinicians and dietitians involved in the nutritional and metabolic care of CeD patients.
Figure 2
Figure 2
Approach to a patient with non-responsive CeD. Abbreviations: CT: computed tomography; MRI: magnetic resonance imaging; PET: positron emission tomography; PEI: pancreatic exocrine insufficiency.
Figure 3
Figure 3
Follow-up algorithm in CeD.
See this image and copyright information in PMC

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