Xenophon Theodoridis1, Maria G Grammatikopoulou2, Arianna Petalidou3, Maria Patelida4, Konstantinos Gkiouras1, Markos Klonizakis5, Stefanos Pittas6, Dimitrios P Bogdanos7. 1. Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences & Dietetics, International Hellenic University, Thessaloniki, Greece. Electronic address: Maria@nutr.teithe.gr. 3. Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece. 4. Department of Nutritional Sciences & Dietetics, International Hellenic University, Thessaloniki, Greece. 5. Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK. 6. Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. 7. Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Division of Transplantation Immunology and Mucosal Biology, MRC Centre for Transplantation, King's College London Medical School, London, UK.
Abstract
OBJECTIVE: Medical nutrition therapy (MNT), by lifelong compliance with a gluten-free diet, is likely the only treatment for celiac disease (CD). Clinical practice guidelines (CPGs) regarding the management of CD emphasize the role of MNT over other treatment options. The aim of the present study was to review and critically appraise CD-specific MNT CPGs and identify areas in need of improvement for better adherence and outcomes. METHODS: A comprehensive search was performed using PubMed, Guidelines International Network (GIN), Google Scholar, gray literature, and websites of CD scientific organizations for CPGs, consensus and practice papers on the dietary management of CD, published in the English language. RESULTS: A total of 12 CPGs were retrieved and critically appraised by three independent reviewers using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument. All CPGs were of low quality based on AGREE II. Among the 12 CPGs, the National Institute for Health and Care Excellence guidelines achieved the highest score and were unanimously recommended without modifications by the three reviewers, whereas the American Gastroenterology Association, Alberta Health Services, British Society of Paediatric Gastroenterology, Hepatology and Nutrition, Clinical Resource Efficiency Support Team, and Federation of International Societies of Pediatric Gastroenterology, Hepatology and Nutrition guidelines received the lowest scores. CONCLUSIONS: The present study reveals the low quality of guidelines regarding the MNT of CD patients, indicating the need for updated and improved guidelines taking into consideration the proposed items of AGREE II.
OBJECTIVE: Medical nutrition therapy (MNT), by lifelong compliance with a gluten-free diet, is likely the only treatment for celiac disease (CD). Clinical practice guidelines (CPGs) regarding the management of CD emphasize the role of MNT over other treatment options. The aim of the present study was to review and critically appraise CD-specific MNT CPGs and identify areas in need of improvement for better adherence and outcomes. METHODS: A comprehensive search was performed using PubMed, Guidelines International Network (GIN), Google Scholar, gray literature, and websites of CD scientific organizations for CPGs, consensus and practice papers on the dietary management of CD, published in the English language. RESULTS: A total of 12 CPGs were retrieved and critically appraised by three independent reviewers using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument. All CPGs were of low quality based on AGREE II. Among the 12 CPGs, the National Institute for Health and Care Excellence guidelines achieved the highest score and were unanimously recommended without modifications by the three reviewers, whereas the American Gastroenterology Association, Alberta Health Services, British Society of Paediatric Gastroenterology, Hepatology and Nutrition, Clinical Resource Efficiency Support Team, and Federation of International Societies of Pediatric Gastroenterology, Hepatology and Nutrition guidelines received the lowest scores. CONCLUSIONS: The present study reveals the low quality of guidelines regarding the MNT of CD patients, indicating the need for updated and improved guidelines taking into consideration the proposed items of AGREE II.