Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Feb;38(1):e13380.
doi: 10.1111/jhn.13380. Epub 2024 Nov 5.

Dietary assessments in individuals living with coeliac disease: key considerations

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

Dietary assessments in individuals living with coeliac disease: key considerations

Anne R Lee et al. J Hum Nutr Diet. 2025 Feb.

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 The latest draft guidance from the US Food and Drug Administration recommends that dietitians experienced in CeD management evaluate patients during the screening and treatment period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.

Keywords: coeliac disease; dietary assessment; gluten‐free diet.

PubMed Disclaimer

Conflict of interest statement

Melinda Dennis is a consultant for Takeda. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overview of the tool development process. CeD, coeliac disease.
See this image and copyright information in PMC

References

    1. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142. - PMC - PubMed
    1. 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(4):669–673. - PubMed
    1. Leffler DA, Acaster S, Gallop K, Dennis M, Kelly CP, Adelman DC. A novel patient‐derived conceptual model of the impact of celiac disease in adults: implications for patient‐reported outcome and health‐related quality‐of‐life instrument development. Value Health. 2017;20(4):637–643. - PubMed
    1. Majsiak E, Choina M, Gray AM, Wysokiński M, Cukrowska B. Clinical manifestation and diagnostic process of celiac disease in Poland—comparison of pediatric and adult patients in retrospective study. Nutrients. 2022;14(3):491. - PMC - PubMed
    1. Leffler DA, Green PHR, Fasano A. Extraintestinal manifestations of coeliac disease. Nat Rev Gastroenterol Hepatol. 2015;12(10):561–571. - PubMed