Is Dietitian Use Associated with Celiac Disease Outcomes?

[annelb]

Is Dietitian Use Associated with Celiac Disease Outcomes?
SriHari Mahadevemail, Suzanne Simpsonemail, Benjamin Lebwohlemail, Suzanne K. Lewisemail, Christina A. Tennysonemail and Peter H. R. Green* email
Celiac Disease Center, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, Suite 934, New York, NY 10032, USA
* Author to whom correspondence should be addressed.
Received: 1 April 2013; in revised form: 6 May 2013 / Accepted: 6 May 2013 / Published: 15 May 2013
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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Abstract: A gluten-free diet (GFD) is the treatment for celiac disease (CD), but due to its complexity, dietitian referral is uniformly recommended. We surveyed patients with CD to determine if dietitian use is associated with quality of life, symptom severity, or GFD adherence. The survey utilized three validated CD-specific instruments: the CD quality of life (CD-QOL), CD symptom index (CSI) and CD adherence test (CDAT). Four hundred and thirteen patients with biopsy-proven CD were eligible for inclusion. The majority (77%) were female and mean BMI was 24.1. Over three-quarters of patients (326, 79%) had seen a dietitian, however, 161 (39%) had seen a dietitian only once. Age, sex, and education level were not associated with 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 was not associated with CD-QOL, CSI, or CDAT scores. Our survey did not show an association between dietitian use and symptom severity, adherence, or quality of life. Delay in diagnosis was associated with poorer outcomes. This is a preliminary study with several limitations, and further prospective analysis is needed to evaluate the benefits and cost-effectiveness of dietitian-referral in the care of celiac disease patients.

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I wonder what sort of dietary advice was given by the dietitians. When I get with someone for 101 help it is all about keeping gluten out of their food and life. I doubt that is the emphasis of the average dietitian. Has anyone been to a dietitian recently? Nine years ago when I was one, I gave her more information about living GF than she gave me. She handed me one outdated brochure. I handed her about 8 articles.
Anne

[NancyM]

That sounds pretty par for the course, Anne! I feel for dietician's because... frankly... they seem useless most of the time. I think what they are taught is set more by public policy and questionable groups like the ADA and AHA rather than being taught stuff that is actually accurate, timely and science-based.

[annelb]

I put up the same article into a FB group and most of the people who responded said they knew more than the dietitian. There were a few who did get help and they mentioned that they saw a dietitian from a celiac center.

I think the big difference in dietary advice for those who have to avoid gluten and dietary advice for any other health condition is that for those with gluten sensitivity it is not just learning what foods to eat but that you can't be exposed to gluten in any way. A diabetic should avoid sugars but does not have to throw away the whole meal if it happens to touch a sugar cube.
Anne