Celiac.com 07/12/2013 - Most doctors and clinicians recommend dietitians for their patients with celiac disease. In fact, the official stance of celiac disease experts is that doctors should recommend a dietitian for every patient with celiac disease. But, do dietitians actually improve the treatment outcomes of celiac disease?

Photo: CC--WBURA team of researchers recently set out to answer that question by surveying patients with celiac disease to determine if dietitian use is associated with quality of life, symptom severity, or gluten-free diet adherence.

The research team included Sri Hari Mahadev, Suzanne Simpson, Benjamin Lebwohl, Suzanne K. Lewis, Christina A. Tennyson and Peter H. R. Green. They are affiliated with the Celiac Disease Center at the Columbia University College of Physicians and Surgeons in New York, USA.

The survey relied on three proven celiac disease-specific elements: the celiac disease quality of life (celiac disease-QOL), celiac disease symptom index (CSI) and celiac disease adherence test (CDAT).

The survey group included four hundred and thirteen patients with biopsy-proven celiac disease. The group was 77% female, with an average BMI of 24.1.

Nearly 80 percent of patients (326), had seen a dietitian, but almost 40 percent of them (161) had only seen a dietitian once. Age, sex, and education level were not factors in dietitian use; nor was BMI (24.6 vs. 24.0, p = 0.45).

On multivariate analysis, adjusting for age gender, education, duration of disease, and body mass index, dietitian use did not change celiac disease-QOL, CSI, or celiac diseaseAT scores. Furthermore, patients who worked with a dietitian did not report any change in symptom severity, dietary adherence, or quality of life. The survey also showed that delay in celiac diagnosis usually results in poorer outcomes overall.

So, in this study, patients with celiac disease who saw a dietitian did no better or worse than those who did not see a dietitian? That mean that doctors just can't say whether people with celiac disease should use, or avoid dietitians.

Because this was a preliminary study with several limitations, researchers need to do a much more comprehensive analysis to more accurately determine the benefits and cost-effectiveness of dietitian-referral for patients with celiac disease.


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